Healthcare Provider Details

I. General information

NPI: 1093302515
Provider Name (Legal Business Name): PAMELA ABBOTT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 BELAIRE DR
HIAWASSEE GA
30546-3313
US

IV. Provider business mailing address

6 MOOSILAUKEE DR
MINERAL BLUFF GA
30559-2509
US

V. Phone/Fax

Practice location:
  • Phone: 706-896-2231
  • Fax:
Mailing address:
  • Phone: 678-739-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001504
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: