=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336880228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE G. HALLEY COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2022
-----------------------------------------------------
Last Update Date | 04/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 S UNIVERSITY BLVD
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36609-7864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-220-6766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 BULL RUN
-----------------------------------------------------
City | SPANISH FORT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36527-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-325-8254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 5175
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------