Healthcare Provider Details

I. General information

NPI: 1922191261
Provider Name (Legal Business Name): ILISHA D NOE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VINE ST
MURFREESBORO TN
37130-3734
US

IV. Provider business mailing address

7419 MEADOWBROOK CIR
KNOXVILLE TN
37918-9798
US

V. Phone/Fax

Practice location:
  • Phone: 615-890-2020
  • Fax:
Mailing address:
  • Phone: 865-755-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA0000001334
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: