Provider Demographics
NPI:1639562374
Name:PATEL, JIGNA A (COTA)
Entity Type:Individual
Prefix:
First Name:JIGNA
Middle Name:A
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 1:24 FOXSPARROW ROAD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3687
Mailing Address - Country:US
Mailing Address - Phone:304-731-9052
Mailing Address - Fax:304-256-0009
Practice Address - Street 1:300 BAKER LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2900
Practice Address - Country:US
Practice Address - Phone:866-466-2475
Practice Address - Fax:610-347-6248
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1997224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant