Healthcare Provider Details

I. General information

NPI: 1235628108
Provider Name (Legal Business Name): ASHLEY RENEE MARTIN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 TROTWOOD AVE
COLUMBIA TN
38401-5074
US

IV. Provider business mailing address

1000 WALDEN CREEK TRCE STE 193I
SPRING HILL TN
37174-6540
US

V. Phone/Fax

Practice location:
  • Phone: 931-398-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA0000003027
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: