Healthcare Provider Details

I. General information

NPI: 1386253011
Provider Name (Legal Business Name): REBECCA ZAVAGE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 COUNTRY CLUB RD
FAIRMONT WV
26554-1306
US

IV. Provider business mailing address

2157 SPRINGHILL FURNACE RD
SMITHFIELD PA
15478-1429
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-9100
  • Fax:
Mailing address:
  • Phone: 724-466-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2314
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: