Provider Demographics
NPI:1679617740
Name:RHONDA L BOERTMANN COTA PA
Entity type:Organization
Organization Name:RHONDA L BOERTMANN COTA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOERTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-801-7095
Mailing Address - Street 1:1666 MONICA ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3968
Mailing Address - Country:US
Mailing Address - Phone:386-801-7095
Mailing Address - Fax:386-789-0124
Practice Address - Street 1:1666 MONICA ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3968
Practice Address - Country:US
Practice Address - Phone:386-801-7095
Practice Address - Fax:386-789-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9565224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty