Provider Demographics
NPI:1639410566
Name:SCOTT, TABATHA JOI (COTA)
Entity Type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:JOI
Last Name:SCOTT
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 1:8299 ENGLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4245
Mailing Address - Country:US
Mailing Address - Phone:678-860-2739
Mailing Address - Fax:
Practice Address - Street 1:2631 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3529
Practice Address - Country:US
Practice Address - Phone:404-325-7994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001533224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant