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General NPI Number Information
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NPI Number | 1720421340
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Entity Type | Individual
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Provider Name | CAROLYN MARIE GUSTIN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 5801 ALLENTOWN ROAD SUITE 410
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City | CAMP SPRINGS
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State | MD
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Zip | 20746
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Country | US
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Telephone | 301-238-4788
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Fax | 301-298-5442
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Provider Business Mailing Address
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Address Line | 5801 ALLENTOWN ROAD SUITE 410
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City | CAMP SPRINGS
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State | MD
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Zip | 20746
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Country | US
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Telephone | 301-238-4788
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Fax | 301-298-5442
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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 | 100000251
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 13076
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | A02011
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License Number State | MD
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