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General NPI Number Information
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NPI Number | 1396005666
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Entity Type | Individual
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Provider Name | CRISTEN MICHELLE FOGLE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 6100 W FRIENDLY AVE
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City | GREENSBORO
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State | NC
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Zip | 27410-4160
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Country | US
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Telephone | 336-292-9952
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Fax |
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Provider Business Mailing Address
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Address Line | 3403 QUAKER RUN DR
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City | GREENSBORO
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State | NC
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Zip | 27410-9168
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Country | US
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Telephone | 614-458-8420
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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 | 7822
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License Number State | NC
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