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General NPI Number Information
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NPI Number | 1619694221
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Entity Type | Individual
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Provider Name | RAVEN HANNAH MARTIN COTA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 2667 ENTERPRISE RD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8217
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Country | US
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Telephone | 321-329-0159
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Fax |
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Provider Business Mailing Address
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Address Line | 34 ASH ST # 2
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City | SPENCER
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State | MA
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Zip | 01562-2316
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Country | US
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Telephone | 386-295-6928
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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 | 19172
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License Number State | FL
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