Healthcare Provider Details

I. General information

NPI: 1558315770
Provider Name (Legal Business Name): LEAH LYNN SWAIN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 WAKE FOREST BUSINESS PARK SUITE D
WAKE FOREST NC
27587-6523
US

IV. Provider business mailing address

833 WAKE FOREST BUSINESS PARK SUITE D
WAKE FOREST NC
27587-6523
US

V. Phone/Fax

Practice location:
  • Phone: 919-556-1700
  • Fax: 919-556-1245
Mailing address:
  • Phone: 919-556-1700
  • Fax: 919-556-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5972
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: