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General NPI Number Information
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NPI Number | 1316375983
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Entity Type | Individual
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Provider Name | DONNA MARIE CHILDRESS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 73 PIEDMONT DR
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City | WHITESBURG
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State | KY
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Zip | 41858-7668
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Country | US
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Telephone | 606-633-3167
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | HAYSI
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State | VA
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Zip | 24256-0846
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Country | US
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Telephone | 276-865-0324
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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 | 0131000473
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License Number State | VA
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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 | 135586
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License Number State | KY
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