Provider Demographics
NPI:1639567589
Name:GENTILE, CHERYL MARIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:MARIE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12984 NASSAU CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-7270
Mailing Address - Country:US
Mailing Address - Phone:951-520-7383
Mailing Address - Fax:
Practice Address - Street 1:12984 NASSAU CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-7270
Practice Address - Country:US
Practice Address - Phone:951-520-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 247224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant