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General NPI Number Information
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NPI Number | 1417621913
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Entity Type | Individual
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Provider Name | CRYSTIE KATELYN HARBER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 39 FERNDALE APARTMENTS RD
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City | PINEVILLE
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State | KY
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Zip | 40977-8578
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Country | US
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Telephone | 606-337-7071
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Fax |
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Provider Business Mailing Address
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Address Line | 2097 WARD HILL RD
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-8017
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Country | US
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Telephone | 276-207-3320
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 271854
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License Number State | KY
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