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General NPI Number Information
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NPI Number | 1346066370
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Entity Type | Individual
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Provider Name | DESTANI AMONI JONES COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1810 BACK CREEK DR
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City | CHARLOTTE
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State | NC
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Zip | 28213-2159
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Country | US
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Telephone | 704-986-7291
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 HORSE PASTURE LN APT 232
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City | CHARLOTTE
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State | NC
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Zip | 28269-3351
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Country | US
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Telephone | 315-679-3224
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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 | 16216
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License Number State | NC
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