Healthcare Provider Details

I. General information

NPI: 1225435993
Provider Name (Legal Business Name): PAMELA TIDWELL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ED TODD CT
MURFREESBORO TN
37128-7742
US

IV. Provider business mailing address

205 ED TODD CT
MURFREESBORO TN
37128-7742
US

V. Phone/Fax

Practice location:
  • Phone: 615-566-7543
  • Fax:
Mailing address:
  • Phone: 615-566-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1158
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: