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General NPI Number Information
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NPI Number | 1083002869
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Entity Type | Individual
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Provider Name | KATIE YACEVICH COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 521 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 828-775-4660
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Fax | 980-225-0189
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Provider Business Mailing Address
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Address Line | 521 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 828-775-4660
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Fax | 980-225-0189
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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 | 9293
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License Number State | NC
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