Healthcare Provider Details

I. General information

NPI: 1104588045
Provider Name (Legal Business Name): ANGELA GENETTE HARDY-JONES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 BELAIRE DR
HIAWASSEE GA
30546-3313
US

IV. Provider business mailing address

120 W VINEYARD RD
HAYESVILLE NC
28904-5336
US

V. Phone/Fax

Practice location:
  • Phone: 706-896-2231
  • Fax:
Mailing address:
  • Phone: 828-360-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA002582
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: