Healthcare Provider Details

I. General information

NPI: 1295659548
Provider Name (Legal Business Name): CENTREESE RAMOS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 QUEEN CITY DR STE D
CHARLOTTE NC
28208-2758
US

IV. Provider business mailing address

1441 PRESTBURY RD NW
CONCORD NC
28027-3570
US

V. Phone/Fax

Practice location:
  • Phone: 203-449-0712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number11867
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: