MEDICARE: HEATHER GILLANDERS COTA

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
1	224Z00000X	Occupational Therapy Assistant	1609	GA

General Provider Information

NPI Number	:	1598807364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GILLANDERS COTA

Provider Business Mailing Address
First Line	:	2810 WEBB BRIDGE RD
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-3746
Country	:	US
Telephone Number	:	810-223-6706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 LAKE PARK DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8982
Country	:	US
Telephone Number	:	810-223-6706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/21/2022

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