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General NPI Number Information
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NPI Number | 1881992980
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Entity Type | Individual
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Provider Name | INGRID BAZELAIS COTA
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Gender | Female
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 05/26/2024
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Provider Practice Location Address
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Address Line | 3412 W 84TH ST STE 102
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City | HIALEAH
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State | FL
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Zip | 33018-4918
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Country | US
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Telephone | 305-827-7344
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Fax |
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Provider Business Mailing Address
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Address Line | 11820 MIRAMAR PKWY STE 203
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City | MIRAMAR
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State | FL
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Zip | 33025-5817
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Country | US
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Telephone | 305-494-6194
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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 | 11008
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License Number State | FL
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