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General NPI Number Information
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NPI Number | 1275066052
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Entity Type | Individual
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Provider Name | JESSICA MISTY BOWAB COTA, CHW, DOULA
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Gender | Female
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 5589 GREENWICH RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6565
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Country | US
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Telephone | 757-401-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 CLAYTOR CT
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City | CHESAPEAKE
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State | VA
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Zip | 23320-8183
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Country | US
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Telephone | 915-276-0881
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 212675
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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