MEDICARE: LAURA ELLEN FIELDEN COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	0131002196	VA

General Provider Information

NPI Number	:	1063284768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELLEN FIELDEN COTA/L

Provider Business Mailing Address
First Line	:	108 SAWGRASS TURN
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-6155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 WILLIAMSBURG LANDING DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-8064
Country	:	US
Telephone Number	:	757-258-2178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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