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General NPI Number Information
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NPI Number | 1265635213
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Entity Type | Individual
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Provider Name | JESSICA NICOLE WHITT COTA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 330 TAZEWELL ST
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City | WYTHEVILLE
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State | VA
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Zip | 24382-2316
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Country | US
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Telephone | 276-228-5411
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Fax |
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Provider Business Mailing Address
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Address Line | 569 KENNEDY DR
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City | POUNDING MILL
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State | VA
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Zip | 24637-3587
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Country | US
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Telephone | 276-963-0997
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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 | C1472
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License Number State | WV
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