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General NPI Number Information
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NPI Number | 1992577613
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Entity Type | Individual
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Provider Name | ALLIE TERRELL COTA
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 6982 PINE FOREST RD
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City | PENSACOLA
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State | FL
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Zip | 32526-8909
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Country | US
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Telephone | 850-750-5203
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 PARKLANE RD APT 713
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City | MCCOMB
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State | MS
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Zip | 39648-4971
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Country | US
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Telephone |
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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 | 19622
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License Number State | FL
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