Provider Demographics
NPI:1891338430
Name:MCMAHON, TASHA NICHOLE (COTA)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:NICHOLE
Last Name:MCMAHON
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 1:7 RORY PHILLIPS VW
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8582
Mailing Address - Country:US
Mailing Address - Phone:828-242-5447
Mailing Address - Fax:
Practice Address - Street 1:78 WEAVER BLVD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9322
Practice Address - Country:US
Practice Address - Phone:828-645-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6592224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty