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General NPI Number Information
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NPI Number | 1699532416
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Entity Type | Individual
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Provider Name | KENNY TRAN NGUYEN COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 2521 LONGVIEW AVE SW APT 1
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City | ROANOKE
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State | VA
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Zip | 24014-1532
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Country | US
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Telephone | 540-353-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 FARMHOUSE CT
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City | ROANOKE
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State | VA
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Zip | 24019-7457
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Country | US
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Telephone | 540-353-4700
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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 | 7298
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License Number State | CA
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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 | 0131002765
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License Number State | VA
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