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General NPI Number Information
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NPI Number | 1831730506
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Entity Type | Individual
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Provider Name | SHIRLEY WEBB COTA
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Gender | Female
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 1477 HUEY ST
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City | WILDWOOD
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State | FL
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Zip | 34785-4233
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Country | US
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Telephone | 352-251-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 11078 SE 168TH LOOP
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City | SUMMERFIELD
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State | FL
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Zip | 34491-1885
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Country | US
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Telephone | 843-442-3211
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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 | 12288
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License Number State | FL
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