Healthcare Provider Details

I. General information

NPI: 1528185683
Provider Name (Legal Business Name): BENJAMIN LEE PITT COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 BLUE JAY 6 RD
COOL RIDGE WV
25825-9560
US

IV. Provider business mailing address

PO BOX 404
COOL RIDGE WV
25825-0404
US

V. Phone/Fax

Practice location:
  • Phone: 304-731-7204
  • Fax:
Mailing address:
  • Phone: 304-731-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC1569
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: