Provider Demographics
NPI:1598328304
Name:MALIGA, NICOLE R (COTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:MALIGA
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 1:58 DOGWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7790
Mailing Address - Country:US
Mailing Address - Phone:901-216-5451
Mailing Address - Fax:
Practice Address - Street 1:36 BAZEBERRY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7754
Practice Address - Country:US
Practice Address - Phone:901-758-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2513225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation