Provider Demographics
NPI:1235522251
Name:PATEL, RESHMA DILIPKUMAR (COTA)
Entity Type:Individual
Prefix:MISS
First Name:RESHMA
Middle Name:DILIPKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 DERBY WAY
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-7781
Mailing Address - Country:US
Mailing Address - Phone:336-471-3227
Mailing Address - Fax:
Practice Address - Street 1:6406 DERBY WAY
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:NC
Practice Address - Zip Code:27370-7781
Practice Address - Country:US
Practice Address - Phone:336-471-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7879172V00000X, 252Y00000X, 251E00000X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker
No252Y00000XAgenciesEarly Intervention Provider Agency
No273Y00000XHospital UnitsRehabilitation Unit