Provider Demographics
NPI:1063718799
Name:DE LA COTERA, LYANET (OTR/L)
Entity type:Individual
Prefix:
First Name:LYANET
Middle Name:
Last Name:DE LA COTERA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12039 SW 132ND CT
Mailing Address - Street 2:5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4783
Mailing Address - Country:US
Mailing Address - Phone:786-417-1303
Mailing Address - Fax:305-232-9693
Practice Address - Street 1:12039 SW 132ND CT
Practice Address - Street 2:5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4783
Practice Address - Country:US
Practice Address - Phone:786-417-1303
Practice Address - Fax:305-232-9693
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist