Healthcare Provider Details

I. General information

NPI: 1679949705
Provider Name (Legal Business Name): SHIANTI MARIE SNYDER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N MAIN ST
MARION VA
24354-4117
US

IV. Provider business mailing address

952 COUNTRY CLUB RD
MARION VA
24354-1508
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-7529
  • Fax: 276-783-7555
Mailing address:
  • Phone: 276-492-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001455
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: