Provider Demographics
NPI:1619434875
Name:NDAIRA, ALLIE NICOLE (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:NICOLE
Last Name:NDAIRA
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:MISS
Other - First Name:ALLIE
Other - Middle Name:NICOLE
Other - Last Name:BERRYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7018 BRASSIE BND
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6033
Mailing Address - Country:US
Mailing Address - Phone:256-366-3368
Mailing Address - Fax:
Practice Address - Street 1:2185 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2728
Practice Address - Country:US
Practice Address - Phone:334-288-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant