MEDICARE: MS. GWYNN PARDUE 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	4592	NC

General Provider Information

NPI Number	:	1699945519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWYNN PARDUE COTA

Provider Business Mailing Address
First Line	:	1048 GRALYN DR
Second Line	:
City	:	HAMPTONVILLE
State	:	NC
Zip	:	27020-8277
Country	:	US
Telephone Number	:	336-468-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 W MAIN ST
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-679-8863
Fax Number	:

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	01/11/2026

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