Healthcare Provider Details

I. General information

NPI: 1770637050
Provider Name (Legal Business Name): HOLLY MCGREGOR RAINEY COTA-L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY ANNE MCGREGOR COTA-L

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

8051 HIGHWAY 493
MERIDIAN MS
39305-9284
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-6777
  • Fax: 601-605-8869
Mailing address:
  • Phone: 601-297-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberTA1803
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: