Healthcare Provider Details

I. General information

NPI: 1689347171
Provider Name (Legal Business Name): ABBY MICHELLE WOOD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SHENANDOAH AVE
FRONT ROYAL VA
22630-3547
US

IV. Provider business mailing address

1096 NEW HOPE RD
BERKELEY SPRINGS WV
25411-3548
US

V. Phone/Fax

Practice location:
  • Phone: 540-636-0242
  • Fax:
Mailing address:
  • Phone: 304-240-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: