Provider Demographics
NPI:1780148957
Name:COX, BRIAN K SR (COTA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:COX
Suffix:SR
Gender:M
Credentials:COTA
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:K
Other - Last Name:COX
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5816 CHASON RIDGE DR APT E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4419
Mailing Address - Country:US
Mailing Address - Phone:850-443-8763
Mailing Address - Fax:
Practice Address - Street 1:5300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15258224Z00000X
GAOTA002135224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant