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General NPI Number Information
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NPI Number | 1851802326
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Entity Type | Individual
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Provider Name | JOHN C HURTADO JR. COTA/L
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Gender | Male
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 3100 TRAMWAY RD
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City | SANFORD
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State | NC
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Zip | 27332-7142
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Country | US
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Telephone | 919-775-5404
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Fax |
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Provider Business Mailing Address
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Address Line | 145 SORGHUM WAY
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1320
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Country | US
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Telephone | 910-231-2392
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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 | 7927
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License Number State | NC
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