=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134609530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KADIE ALYSSA PRITCHARD COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2018
-----------------------------------------------------
Last Update Date | 08/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 BRANCHVIEW DR NE
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-3498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-723-4705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2305 APPLEGATE DR
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28027-9669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-621-0557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 11937
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
=====================================================
Legacy Identifiers
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 978350968
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State | NC
-----------------------------------------------------
Identifier Issuer | GPA
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 978350968
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State | NC
-----------------------------------------------------
Identifier Issuer | GPA
-----------------------------------------------------