Healthcare Provider Details

I. General information

NPI: 1265721484
Provider Name (Legal Business Name): LAURI ANN CUOZZO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/07/2020
Certification Date: 03/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HALSTEAD BLVD
ELIZABETH CITY NC
27909-6920
US

IV. Provider business mailing address

2740 STANTONSBURG RD APT IG
GREENVILLE NC
27834-7272
US

V. Phone/Fax

Practice location:
  • Phone: 910-368-9099
  • Fax:
Mailing address:
  • Phone: 910-368-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: