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General NPI Number Information
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NPI Number | 1083992069
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Entity Type | Individual
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Provider Name | MARIE PIERRE GRETCHAIDA LOUIS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 110 BRANDYWINE BLVD
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1500
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Country | US
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Telephone | 770-461-4279
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Fax |
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Provider Business Mailing Address
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Address Line | 620 WINDSOR PL
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City | FAIRBURN
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State | GA
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Zip | 30213-6444
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Country | US
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Telephone | 770-629-5766
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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 | OTA1281
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License Number State | GA
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