Healthcare Provider Details

I. General information

NPI: 1720722325
Provider Name (Legal Business Name): MORGAN PAIGE JOHNSON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

IV. Provider business mailing address

6352 TOLLESON RD
ADAMS TN
37010-5070
US

V. Phone/Fax

Practice location:
  • Phone: 800-920-0834
  • Fax: 931-233-9970
Mailing address:
  • Phone: 615-946-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: