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NPI Code Detail

MEDICARE: NICOLE MARIE TEATER COTA

MEDICARE: NICOLE MARIE TEATER COTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA 11355FL

General Provider Information

NPI Number : 1811291057
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE TEATER COTA
Provider Business Mailing Address
First Line : 945 GLENWOOD RD
Second Line :
City : DELAND
State : FL
Zip : 32720-2376
Country : US
Telephone Number : 386-956-3380
Fax Number :
Provider Business Practice Location Address
First Line : 500 GRAND PLAZA DR
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-7900
Country : US
Telephone Number : 386-775-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2011
Last Update Date : 01/03/2011

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Directions to “ NICOLE MARIE TEATER COTA” Practice Location

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