Provider Demographics
NPI:1023204823
Name:JOSEPHA, IRAISA M (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:IRAISA
Middle Name:M
Last Name:JOSEPHA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 102 BLG-1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1610
Mailing Address - Country:US
Mailing Address - Phone:866-587-9922
Mailing Address - Fax:678-587-9993
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 102 BLG-1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1610
Practice Address - Country:US
Practice Address - Phone:866-587-9922
Practice Address - Fax:678-587-9993
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health