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General NPI Number Information
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NPI Number | 1659615185
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Entity Type | Individual
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Provider Name | LETITIA ARDELLA DURHAM COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 405 STANAFORD RD
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City | BECKLEY
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State | WV
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Zip | 25801-3143
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Country | US
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Telephone | 304-252-6317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2036
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City | BECKLEY
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State | WV
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Zip | 25802-2036
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Country | US
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Telephone | 304-663-6139
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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 | C1487
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License Number State | WV
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