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General NPI Number Information
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NPI Number | 1538382965
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Entity Type | Individual
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Provider Name | CANDACE C. DEILING COTA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 409 S 10TH ST
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City | HAINES CITY
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State | FL
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Zip | 33844-5603
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Country | US
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Telephone | 863-422-8656
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Fax |
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Provider Business Mailing Address
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Address Line | 2658 EVERLETH CT
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City | LAKELAND
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State | FL
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Zip | 33810-5133
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Country | US
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Telephone | 863-858-4653
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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 | OTA00005440
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License Number State | FL
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