Individual
JESSICA MARIE COSTA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
9800 W KINCEY AV, ST 180, HUNTERSVILLE, NC 28078
(704) 948-2701
(704) 948-2859
Mailing address
136 HAMPSHIRE DR, MOORESVILLE, NC 28115
(704) 895-6940
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4444
NC
Other
Enumeration date
03/23/2006
Last updated
07/08/2007
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