Provider Demographics
NPI:1669673471
Name:REID, NORVETTA ANN (COTA)
Entity Type:Individual
Prefix:
First Name:NORVETTA
Middle Name:ANN
Last Name:REID
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 1:22648 CUYAMA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-7603
Mailing Address - Country:US
Mailing Address - Phone:760-912-4607
Mailing Address - Fax:
Practice Address - Street 1:4444 W MEADOW AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-1652
Practice Address - Country:US
Practice Address - Phone:559-627-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1301224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant