Provider Demographics
NPI:1821316720
Name:TOURAY, FATOUMATA (COTA)
Entity Type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:
Last Name:TOURAY
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 1:303 1/2 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4546
Mailing Address - Country:US
Mailing Address - Phone:240-401-2284
Mailing Address - Fax:
Practice Address - Street 1:303 1/2 PRINCE ST APT 11
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4537
Practice Address - Country:US
Practice Address - Phone:240-401-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2927224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant