Provider Demographics
NPI:1114179769
Name:COTTOS, ANDREA (MS/OTRL)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:COTTOS
Suffix:
Gender:F
Credentials:MS/OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11539 PARK WOODS CIR
Mailing Address - Street 2:STE 502
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4413
Mailing Address - Country:US
Mailing Address - Phone:678-527-3224
Mailing Address - Fax:
Practice Address - Street 1:11539 PARK WOODS CIR
Practice Address - Street 2:STE 502
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4413
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT004815OtherGEROGIA STATE LICENSURE