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General NPI Number Information
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NPI Number | 1831413178
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Entity Type | Individual
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Provider Name | CHENG CHA COTA
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Gender | Female
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 422 RENOWN CT
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City | WINDER
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State | GA
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Zip | 30680-4022
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Country | US
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Telephone | 678-898-9404
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Fax |
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Provider Business Mailing Address
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Address Line | 5266 CAPAC RD
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City | MUSSEY
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State | MI
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Zip | 48014-1901
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Country | US
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Telephone |
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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 | OTA002281
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License Number State | GA
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