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General NPI Number Information
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NPI Number | 1528339033
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Entity Type | Individual
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Provider Name | KRISTEN MARIE DUNNE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 216 SANTA BARBARA BLVD
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City | CAPE CORAL
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State | FL
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Zip | 33991-2031
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Country | US
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Telephone | 239-242-8473
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Fax |
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Provider Business Mailing Address
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Address Line | 19 SW 19TH CT
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City | CAPE CORAL
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State | FL
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Zip | 33991-1390
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Country | US
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Telephone | 239-247-4990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 592
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License Number State | FL
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