Healthcare Provider Details

I. General information

NPI: 1386983724
Provider Name (Legal Business Name): TANET M RAYMER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANET M SANDISON COTA

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SPRING FOREST RD
RALEIGH NC
27606
US

IV. Provider business mailing address

1506 HUNTER STREET
STERLING IL
61081
US

V. Phone/Fax

Practice location:
  • Phone: 919-424-5086
  • Fax:
Mailing address:
  • Phone: 815-441-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057001772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: