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General NPI Number Information
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NPI Number | 1508660523
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Entity Type | Individual
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Provider Name | BRITTANY KALEA LACKS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 184 BUFFALO RD
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City | CLARKSVILLE
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State | VA
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Zip | 23927-9010
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Country | US
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Telephone | 434-206-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 MORTONS FERRY RD
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City | NATHALIE
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State | VA
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Zip | 24577-3056
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Country | US
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Telephone | 434-471-3759
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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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