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General NPI Number Information
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NPI Number | 1235666496
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Entity Type | Individual
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Provider Name | ASHLEA WILLIS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 05/18/2017
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Provider Practice Location Address
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Address Line | 5010 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-5074
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Country | US
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Telephone | 931-398-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 5331 MILL RUN DR
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City | MARIETTA
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State | GA
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Zip | 30068-2862
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Country | US
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Telephone |
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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 | 2866
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License Number State | TN
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