Provider Demographics
NPI:1588150627
Name:DUBOSE, TEMEKA (COTA)
Entity type:Individual
Prefix:MRS
First Name:TEMEKA
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TEMEKA
Other - Middle Name:
Other - Last Name:DUBOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1576 JONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-4449
Mailing Address - Country:US
Mailing Address - Phone:706-347-6807
Mailing Address - Fax:
Practice Address - Street 1:2000 QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-5734
Practice Address - Country:US
Practice Address - Phone:706-347-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002424224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant