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General NPI Number Information
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NPI Number | 1467816835
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Entity Type | Individual
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Provider Name | MARILYN JENNIFER SMITH-HAYNES COTA, CAPS
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 3617 EBENEZER RD
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City | MARIETTA
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State | GA
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Zip | 30066-2819
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Country | US
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Telephone | 757-589-0864
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Fax | 770-805-0556
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Provider Business Mailing Address
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Address Line | 3617 EBENEZER RD
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City | MARIETTA
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State | GA
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Zip | 30066-2819
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Country | US
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Telephone | 757-589-0864
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Fax | 770-805-0556
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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 | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number | OTA000977
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License Number State | GA
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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 | 213831
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License Number State | TX
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