Provider Demographics
NPI:1760195192
Name:TORRES ROMAN, MARIA TERESA (COTA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:TORRES ROMAN
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 1:3113 HUDSON POND LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6697
Mailing Address - Country:US
Mailing Address - Phone:787-214-0158
Mailing Address - Fax:
Practice Address - Street 1:2320 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1317
Practice Address - Country:US
Practice Address - Phone:770-393-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant