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General NPI Number Information
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NPI Number | 1710505243
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Entity Type | Individual
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Provider Name | MARTH EILEEN HERARD COTA
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Gender | Female
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 5901 MACARTHUR BLVD NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2541
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Country | US
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Telephone | 202-349-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 6850 RICHMOND HWY APT 432
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City | ALEXANDRIA
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State | VA
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Zip | 22306-1765
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Country | US
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Telephone | 561-801-2849
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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 | 0131002373
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License Number State | VA
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