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General NPI Number Information
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NPI Number | 1376794065
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Entity Type | Individual
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Provider Name | PATRICIA SUSAN WRIGHT COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 4788 HIGHWAY 705
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City | ROBBINS
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State | NC
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Zip | 27325
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Country | US
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Telephone | 910-585-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 183 CRAWLEY CREEK RD
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City | CARTHAGE
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State | NC
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Zip | 28327-8745
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Country | US
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Telephone | 901-947-3544
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 3613
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License Number State | NC
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