Healthcare Provider Details

I. General information

NPI: 1811150295
Provider Name (Legal Business Name): JULIE ELIZABETH GRISHAM COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HEALTH CARE DR
CARTHAGE TN
37030-1168
US

IV. Provider business mailing address

112 HEALTH CARE DR
CARTHAGE TN
37030-1168
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-7469
  • Fax: 615-735-3210
Mailing address:
  • Phone: 615-735-7469
  • Fax: 615-735-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number766
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: