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General NPI Number Information
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NPI Number | 1578045936
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Entity Type | Individual
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Provider Name | BETSY MIRANDA COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/02/2018
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Last Update Date | 09/02/2018
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Provider Practice Location Address
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Address Line | 20535 EARHART PL
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-3581
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Country | US
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Telephone | 703-404-5241
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Fax |
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Provider Business Mailing Address
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Address Line | 12126 DALEWOOD DR
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City | SILVER SPRING
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State | MD
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Zip | 20902-1142
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Country | US
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Telephone | 301-518-7913
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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 | 0131-001887
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License Number State | VA
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