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General NPI Number Information
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NPI Number | 1811147432
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Entity Type | Individual
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Provider Name | CAROL BALES COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 1012 JAMESTOWN WAY
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City | MARYVILLE
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State | TN
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Zip | 37803-5865
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Country | US
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Telephone | 865-984-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 904 HENRIETTA DR
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City | KNOXVILLE
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State | TN
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Zip | 37912-3154
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Country | US
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Telephone | 865-688-3660
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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 | OTA0000001598
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License Number State | TN
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