Healthcare Provider Details

I. General information

NPI: 1497270102
Provider Name (Legal Business Name): DANA LYNN HAYNER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 KEMPSVILLE RD
NORFOLK VA
23502-2205
US

IV. Provider business mailing address

1009 ANTIOCH CIR
VIRGINIA BEACH VA
23464-3710
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-5001
  • Fax:
Mailing address:
  • Phone: 757-572-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001842
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: