Healthcare Provider Details

I. General information

NPI: 1235522251
Provider Name (Legal Business Name): RESHMA DILIPKUMAR PATEL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 DERBY WAY
TRINITY NC
27370-7781
US

IV. Provider business mailing address

6406 DERBY WAY
TRINITY NC
27370-7781
US

V. Phone/Fax

Practice location:
  • Phone: 336-471-3227
  • Fax:
Mailing address:
  • Phone: 336-471-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number7879
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number7879
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7879
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number7879
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: