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General NPI Number Information
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NPI Number | 1932538550
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Entity Type | Individual
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Provider Name | DORIS NYARADZAI LANG C.O.T.A.
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 2786 56TH ST SW
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City | WYOMING
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State | MI
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Zip | 49418-8708
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Country | US
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Telephone | 616-261-3960
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Fax | 616-261-3925
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Provider Business Mailing Address
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Address Line | 3040 WATERCHASE WAY SW APT 312
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City | WYOMING
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State | MI
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Zip | 49519-5955
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Country | US
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Telephone | 616-719-7353
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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 | 520007194
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License Number State | MI
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