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General NPI Number Information
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NPI Number | 1952557720
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Entity Type | Individual
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Provider Name | DANA W BLACK COTA
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Gender | Female
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 1700 NE INDIAN RIVER DR
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City | JENSEN BEACH
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State | FL
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Zip | 34957-5853
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Country | US
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Telephone | 772-225-1355
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Fax | 772-225-8037
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Provider Business Mailing Address
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Address Line | 2222 SULLIVAN TRL
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City | EASTON
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State | PA
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Zip | 18040-7958
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Country | US
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Telephone | 800-944-9782
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Fax | 610-438-2024
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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 | OTA9730
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT19708
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License Number State | FL
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