Healthcare Provider Details

I. General information

NPI: 1952678369
Provider Name (Legal Business Name): ROBBIE ALLEN HONAKER COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RANDOLPH ST
RADFORD VA
24141-2430
US

IV. Provider business mailing address

700 RANDOLPH ST
RADFORD VA
24141-2430
US

V. Phone/Fax

Practice location:
  • Phone: 540-633-3708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131000331
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: