Provider Demographics
NPI:1033703228
Name:ATTAALLA, ATEF (COTA)
Entity Type:Individual
Prefix:MR
First Name:ATEF
Middle Name:
Last Name:ATTAALLA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ISLEWORTH DR APT 3209
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1680
Mailing Address - Country:US
Mailing Address - Phone:646-744-5083
Mailing Address - Fax:
Practice Address - Street 1:3000 ISLEWORTH DR APT 3209
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1680
Practice Address - Country:US
Practice Address - Phone:646-744-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010450226000000X
TN3539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant