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General NPI Number Information
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NPI Number | 1760956155
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Entity Type | Individual
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Provider Name | KIARA DE'LANE SCREEN COTA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 103 ROSEHILL DR
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-4843
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Country | US
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Telephone | 434-517-7527
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 RIVER RD
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-6017
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Country | US
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Telephone | 434-222-8023
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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 | 0131001261
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License Number State | VA
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