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General NPI Number Information
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NPI Number | 1730632720
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Entity Type | Individual
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Provider Name | RAQUEL LOPEZ COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 17754 NW 59TH AVE 102
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City | HIALEAH
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State | FL
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Zip | 33015-5149
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Country | US
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Telephone | 786-768-3465
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Fax | 866-546-3080
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Provider Business Mailing Address
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Address Line | 6621 LAKE BLUE DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-3005
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Country | US
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Telephone | 786-768-3465
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Fax | 866-546-3080
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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 | OTA11986
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License Number State | FL
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