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General NPI Number Information
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NPI Number | 1346709490
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Entity Type | Individual
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Provider Name | JEMMA MANUKYAN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 6542 GWIN RD
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City | OAKLAND
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State | CA
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Zip | 94611-1204
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Country | US
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Telephone | 401-932-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 89 NORFOLK ST
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City | CRANSTON
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State | RI
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Zip | 02910-2717
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Country | US
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Telephone | 401-932-9398
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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 | 4779
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License Number State | CA
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