Provider Demographics
NPI:1588358931
Name:FELIX, CYNTHIA NKEMJIKA (COTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NKEMJIKA
Last Name:FELIX
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 1:3488 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4228
Mailing Address - Country:US
Mailing Address - Phone:470-350-0920
Mailing Address - Fax:
Practice Address - Street 1:1170 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7649
Practice Address - Country:US
Practice Address - Phone:202-320-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002407224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty