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General NPI Number Information
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NPI Number | 1407015969
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Entity Type | Individual
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Provider Name | MERRIE CATHERINE FANNIN COTA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 180 HOSPITAL CORPS BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547
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Country | US
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Telephone | 910-449-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 318 CROSSWOOD DR
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City | HOLLY RIDGE
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State | NC
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Zip | 28445-8783
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Country | US
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Telephone | 910-389-2856
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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 | 6616
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License Number State | NC
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