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NPI Code Detail

MEDICARE: MS. CANDICE ELISABETHE ARTHUR COTA/L

MEDICARE: MS. CANDICE ELISABETHE ARTHUR 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 Assistant0131000698VA

General Provider Information

NPI Number : 1396030474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CANDICE ELISABETHE ARTHUR COTA/L
Provider Business Mailing Address
First Line : 4355 PHEASANT RIDGE RD
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5272
Country : US
Telephone Number : 540-725-8210
Fax Number :
Provider Business Practice Location Address
First Line : 4355 PHEASANT RIDGE RD
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5272
Country : US
Telephone Number : 540-725-8210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2011
Last Update Date : 01/31/2013

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