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NPI Code Detail

MEDICARE: AUNDREA DAVIS COTA/L

MEDICARE: AUNDREA DAVIS 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 Assistant1441TN

General Provider Information

NPI Number : 1104582238
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUNDREA DAVIS COTA/L
Provider Business Mailing Address
First Line : 518 LIVE OAK RD
Second Line :
City : RINGGOLD
State : GA
Zip : 30736-3195
Country : US
Telephone Number : 423-987-9737
Fax Number :
Provider Business Practice Location Address
First Line : 2255 CANDIES LN NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-2661
Country : US
Telephone Number : 423-472-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2021
Last Update Date : 11/12/2021

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