Healthcare Provider Details

I. General information

NPI: 1386071751
Provider Name (Legal Business Name): SARAH ELIZABETH NELSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NORTHSIDE PKWY NW
ATLANTA GA
30327-1563
US

IV. Provider business mailing address

3154 GRANBY AVE
SCOTTDALE GA
30079-1511
US

V. Phone/Fax

Practice location:
  • Phone: 404-238-9200
  • Fax:
Mailing address:
  • Phone: 770-280-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA001603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: