Healthcare Provider Details

I. General information

NPI: 1821245499
Provider Name (Legal Business Name): CHERYL ANN HUNTER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 71 BOX 222
ATHENS WV
24712-9002
US

IV. Provider business mailing address

HC 71 BOX 222
ATHENS WV
24712-9002
US

V. Phone/Fax

Practice location:
  • Phone: 304-920-2594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC1055
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: