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General NPI Number Information
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NPI Number | 1184996084
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Entity Type | Individual
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Provider Name | EDNA ANN COOPER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 6300 SAGEWOOD DR SUITE H423
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City | PARK CITY
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State | UT
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Zip | 84098-7502
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Country | US
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Telephone | 888-499-4904
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Fax | 435-658-4954
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Provider Business Mailing Address
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Address Line | 1889 OLD HWY 29
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City | HARTWELL
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State | GA
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Zip | 30643-8703
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Country | US
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Telephone | 706-680-9064
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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 | OTA001141
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License Number State | GA
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