Healthcare Provider Details

I. General information

NPI: 1730544032
Provider Name (Legal Business Name): ASHLEY ELIZABETH HOLDEN COTA, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 REAS FORD RD
EARLYSVILLE VA
22936
US

IV. Provider business mailing address

832 REAS FORD RD
EARLYSVILLE VA
22936
US

V. Phone/Fax

Practice location:
  • Phone: 802-558-5139
  • Fax:
Mailing address:
  • Phone: 802-558-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2306603387
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0131000980
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: