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General NPI Number Information
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NPI Number | 1396382610
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Entity Type | Individual
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Provider Name | JASON PACK COTA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 9022 RICHFIELD LN
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City | KNOXVILLE
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State | TN
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Zip | 37924-4579
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Country | US
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Telephone | 865-279-6718
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Fax | 855-232-8604
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Provider Business Mailing Address
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Address Line | 9022 RICHFIELD LN
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City | KNOXVILLE
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State | TN
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Zip | 37924-4579
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Country | US
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Telephone | 865-293-9449
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Fax | 855-232-8604
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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 | 2473
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License Number State | TN
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