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General NPI Number Information
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NPI Number | 1861177883
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Entity Type | Individual
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Provider Name | LEANDRA BROWN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 6135 WILLIAMS RD
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City | TALLAHASSEE
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State | FL
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Zip | 32311-9107
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Country | US
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Telephone | 850-294-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 807 CULBRETH ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4735
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Country | US
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Telephone | 229-205-5668
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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 |
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License Number State |
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