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General NPI Number Information
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NPI Number | 1679949705
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Entity Type | Individual
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Provider Name | SHIANTI MARIE SNYDER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 927 N MAIN ST
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City | MARION
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State | VA
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Zip | 24354-4117
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Country | US
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Telephone | 276-783-7529
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Fax | 276-783-7555
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Provider Business Mailing Address
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Address Line | 952 COUNTRY CLUB RD
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City | MARION
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State | VA
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Zip | 24354-1508
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Country | US
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Telephone | 276-492-7755
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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 | 0131001455
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License Number State | VA
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