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General NPI Number Information
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NPI Number | 1184004491
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Entity Type | Individual
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Provider Name | JAN GRAHAM COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 3001 SPRING FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27616-2815
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Country | US
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Telephone | 919-424-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 OLD SALISBURY CONCORD RD
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City | CONCORD
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State | NC
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Zip | 28025-1545
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Country | US
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Telephone | 980-521-0601
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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 | 0661
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License Number State | NC
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