Healthcare Provider Details

I. General information

NPI: 1437819117
Provider Name (Legal Business Name): CHRISTI STANLEY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 BLACKBURN ST
BECKLEY WV
25801-9632
US

IV. Provider business mailing address

165 BLACKBURN ST
BECKLEY WV
25801-9632
US

V. Phone/Fax

Practice location:
  • Phone: 304-365-3292
  • Fax:
Mailing address:
  • Phone: 304-365-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC2403
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2403
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: