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General NPI Number Information
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NPI Number | 1750025904
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Entity Type | Individual
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Provider Name | JESSANN MARIE MALDONADO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 1000 CORPORATE DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-3634
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Country | US
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Telephone | 954-210-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SHARPS LOT RD
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City | SWANSEA
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State | MA
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Zip | 02777-3734
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Country | US
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Telephone | 508-558-5674
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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 | 2900
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License Number State | MA
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