=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689001885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA WHITTINGTON COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2013
-----------------------------------------------------
Last Update Date | 10/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37380 HARMONY DR
-----------------------------------------------------
City | SELBYVILLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19975-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-235-4368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37380 HARMONY DR
-----------------------------------------------------
City | SELBYVILLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19975-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-235-4368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | A02059
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | U2-0001412
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------