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General NPI Number Information
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NPI Number | 1003478702
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Entity Type | Individual
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Provider Name | AUTUMN BALLARD COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 935 WAYNE RD
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City | SAVANNAH
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State | TN
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Zip | 38372-1904
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Country | US
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Telephone | 731-727-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 65 SHANNON LN
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City | COUNCE
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State | TN
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Zip | 38326-2044
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Country | US
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Telephone | 731-438-1140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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