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General NPI Number Information
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NPI Number | 1417712373
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Entity Type | Individual
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Provider Name | ALEXANDRIA NICHOLE WILSON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 1610 28TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2641
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Country | US
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Telephone | 740-354-3135
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 GEPHART RD
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City | WHEELERSBURG
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State | OH
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Zip | 45694-8652
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Country | US
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Telephone | 740-464-7648
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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 | OTA007776
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License Number State | OH
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