=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952621724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIELA NEGRIN LOPEZ COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2010
-----------------------------------------------------
Last Update Date | 06/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13335 SW 124TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-378-5247
-----------------------------------------------------
Fax | 305-378-6736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13335 SW 124TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-378-5247
-----------------------------------------------------
Fax | 305-378-6736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA10845
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------