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General NPI Number Information
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NPI Number | 1275065419
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Entity Type | Individual
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Provider Name | KYLE ASHTON GREEN COTA
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Gender | Female
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 304 EDMOND ST
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City | APPALACHIA
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State | VA
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Zip | 24216-2008
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Country | US
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Telephone | 276-365-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 304 EDMOND ST
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City | APPALACHIA
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State | VA
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Zip | 24216-2008
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Country | US
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Telephone | 276-365-5301
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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 | OTA0000002802
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0131001647
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License Number State | VA
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