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General NPI Number Information
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NPI Number | 1265556906
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Entity Type | Individual
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Provider Name | TANYAA SHAREE WILLIAMS COTA
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4560 PRINCESS ANNE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7905
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Country | US
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Telephone | 757-474-1249
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 CATHEDRAL DR
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City | SUFFOLK
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State | VA
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Zip | 23434-8182
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Country | US
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Telephone | 757-539-1719
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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 | 1076780
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License Number State | VA
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