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General NPI Number Information
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NPI Number | 1417566746
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Entity Type | Individual
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Provider Name | ASHLEY MARTIN GARDNER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 925 NEW GARDEN RD
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City | GREENSBORO
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State | NC
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Zip | 27410-3233
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Country | US
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Telephone | 336-369-2559
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Fax |
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Provider Business Mailing Address
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Address Line | 1237 CROFTON DR
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City | WAXHAW
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State | NC
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Zip | 28173-0150
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Country | US
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Telephone | 704-519-8980
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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 | 13340
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License Number State | NC
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