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General NPI Number Information
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NPI Number | 1992121123
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Entity Type | Individual
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Provider Name | MATTHEW TOMB COTA
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Gender | Male
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 1442 BUCKHORN RD
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City | SYKESVILLE
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State | MD
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Zip | 21784-9303
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Country | US
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Telephone | 410-795-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 4617 KINGS MILL WAY
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City | OWINGS MILLS
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State | MD
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Zip | 21117-6186
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Country | US
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Telephone | 716-640-9059
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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 | A01954
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License Number State | MD
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