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General NPI Number Information
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NPI Number | 1265801179
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Entity Type | Individual
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Provider Name | NADEZDA KLINEVA COTA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 6975 SW NYBERG ST APT V103
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City | TUALATIN
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State | OR
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Zip | 97062-8233
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Country | US
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Telephone | 971-277-0136
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Fax |
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Provider Business Mailing Address
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Address Line | ROSA LUKSEMBURG 10, ARMAVIR, KRASNODAR REGION, 352900,
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City | ARMAVIR
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State | KRASNODAR REGION
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Zip | 352900
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Country | RU
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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 | 340078
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License Number State | OR
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