1881988558 NPI number — MRS. MICHELE WAKELEY MCGHEE COTA

Table of content: MRS. MICHELE WAKELEY MCGHEE COTA (NPI 1881988558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881988558 NPI number — MRS. MICHELE WAKELEY MCGHEE COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGHEE
Provider First Name:
MICHELE
Provider Middle Name:
WAKELEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGHEE
Provider Other First Name:
MICHELE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881988558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10190 BOCA ENTRADA BLVD
Provider Second Line Business Mailing Address:
APT 120
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33428-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-862-7415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10190 BOCA ENTRADA BLVD
Provider Second Line Business Practice Location Address:
APT 120
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33428-5831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-862-7415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  5525 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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