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General NPI Number Information
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NPI Number | 1295371383
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Entity Type | Individual
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Provider Name | COURTNEY PRYDE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/23/2019
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 13700 N GAYTON RD
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City | RICHMOND
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State | VA
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Zip | 23233-7017
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Country | US
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Telephone | 804-360-1960
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Fax |
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Provider Business Mailing Address
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Address Line | 709 TREYS DR
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City | WINCHESTER
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State | VA
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Zip | 22601-3233
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Country | US
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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 | 0131002292
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License Number State | VA
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