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General NPI Number Information
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NPI Number | 1033725031
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Entity Type | Individual
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Provider Name | MADISYN LEIGH TAYLOR COTA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 4560 SOUTH BLVD STE 310
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1160
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Country | US
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Telephone | 757-490-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 253 GREEN VIEW RD
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City | MOYOCK
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State | NC
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Zip | 27958-9297
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Country | US
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Telephone | 757-746-4536
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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 | 0131002595
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License Number State | VA
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