=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164873105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE HILLIARD COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2016
-----------------------------------------------------
Last Update Date | 06/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 N AUGUSTA ST
-----------------------------------------------------
City | STAUNTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24401-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-886-6233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 RIFE RD APT 11G
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22980-4951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-303-3793
-----------------------------------------------------
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 | 0131001544
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------