Healthcare Provider Details

I. General information

NPI: 1639410566
Provider Name (Legal Business Name): TABATHA JOI SCOTT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 N DRUID HILLS RD NE
ATLANTA GA
30329-3529
US

IV. Provider business mailing address

8299 ENGLEWOOD TRL
RIVERDALE GA
30274-4245
US

V. Phone/Fax

Practice location:
  • Phone: 404-325-7994
  • Fax:
Mailing address:
  • Phone: 678-860-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA001533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: