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General NPI Number Information
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NPI Number | 1639571946
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Entity Type | Individual
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Provider Name | MARLO JOLLEY COTA
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Gender | Female
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 9430 LIVE OAK PLACE #405
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City | DAVIE
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State | FL
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Zip | 33326-6706
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Country | US
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Telephone | 954-505-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 9430 LIVE OAK PL #405
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City | DAVIE
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State | FL
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Zip | 33324-4763
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Country | US
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Telephone | 954-505-1937
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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 | 329372
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License Number State | FL
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