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General NPI Number Information
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NPI Number | 1417166133
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Entity Type | Individual
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Provider Name | AMY ELIZABETH KELLY COTA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1001 SAM PERRY BLVD
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4453
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Country | US
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Telephone | 540-785-1149
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Fax |
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Provider Business Mailing Address
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Address Line | 10305 NAPOLEON ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-8023
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Country | US
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Telephone | 540-310-0142
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 1014395
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License Number State | VA
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