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NPI Code Detail

MEDICARE: MRS. CHRISTINA KAY DEMENT COTA/L

MEDICARE: MRS. CHRISTINA KAY DEMENT COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant6608NC

General Provider Information

NPI Number : 1356884373
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINA KAY DEMENT COTA/L
Provider Business Mailing Address
First Line : 6000 PARK SOUTH DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3298
Country : US
Telephone Number : 704-643-1400
Fax Number :
Provider Business Practice Location Address
First Line : 6000 PARK SOUTH DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3298
Country : US
Telephone Number : 704-643-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2016
Last Update Date : 11/22/2016

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