Healthcare Provider Details

I. General information

NPI: 1639303787
Provider Name (Legal Business Name): GUERLANDE EXALIEN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SHAMROCK DR
CHARLOTTE NC
28215-3214
US

IV. Provider business mailing address

8816 AVEBURY DR APT C
CHARLOTTE NC
28213-3161
US

V. Phone/Fax

Practice location:
  • Phone: 919-630-3563
  • Fax:
Mailing address:
  • Phone: 919-630-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5442
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: