Healthcare Provider Details

I. General information

NPI: 1902002967
Provider Name (Legal Business Name): KAREN RAMONIA ROSS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOL LN
RICHMOND VA
23223-3912
US

IV. Provider business mailing address

2820 GROVELAND AVE
RICHMOND VA
23222-3817
US

V. Phone/Fax

Practice location:
  • Phone: 804-343-6121
  • Fax:
Mailing address:
  • Phone: 804-343-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number995878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: