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General NPI Number Information
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NPI Number | 1770616138
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Entity Type | Individual
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Provider Name | KELLENE SHEY JACKSON COTA
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 01/10/2010
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Provider Practice Location Address
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Address Line | 1301 W MAITLAND BLVD
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City | MAITLAND
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State | FL
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Zip | 32751-4338
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Country | US
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Telephone | 407-645-0034
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Fax |
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Provider Business Mailing Address
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Address Line | 315 HOWARD BLVD
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City | LONGWOOD
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State | FL
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Zip | 32750-4616
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Country | US
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Telephone | 407-402-3203
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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 | 9463
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License Number State | FL
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