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NPI Code Detail

MEDICARE: DORIAN H. JORDAN COTA/L

MEDICARE: DORIAN H. JORDAN COTA/L
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 AssistantOTA002209GA

General Provider Information

NPI Number : 1063985000
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIAN H. JORDAN COTA/L
Provider Business Mailing Address
First Line : 805 HARMON DR APT D14
Second Line :
City : VALDOSTA
State : GA
Zip : 31601-3822
Country : US
Telephone Number : 229-646-0647
Fax Number :
Provider Business Practice Location Address
First Line : 1901 W SCREVEN ST
Second Line :
City : QUITMAN
State : GA
Zip : 31643-3913
Country : US
Telephone Number : 229-263-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2019
Last Update Date : 01/02/2019

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