Healthcare Provider Details

I. General information

NPI: 1053893206
Provider Name (Legal Business Name): LEAH ADAMS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CLOCKTOWER RIDGE DR
WINCHESTER VA
22603-3878
US

IV. Provider business mailing address

2560 BOYER RD
FORT VALLEY VA
22652-1912
US

V. Phone/Fax

Practice location:
  • Phone: 540-431-2800
  • Fax:
Mailing address:
  • Phone: 540-233-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131002022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: