MEDICARE: REBECCA SUE MCAFEE COTAL

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	OTA103	TN

General Provider Information

NPI Number	:	1083896609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SUE MCAFEE COTAL

Provider Business Mailing Address
First Line	:	PO BOX 910
Second Line	:	GREENE VALLEY DEVELOPMENTAL CENTER
City	:	GREENEVILLE
State	:	TN
Zip	:	37744-0910
Country	:	US
Telephone Number	:	423-787-6800
Fax Number	:	423-787-6574

Provider Business Practice Location Address
First Line	:	4850 EAST ANDREW JOHNSON HIGHWAY
Second Line	:	GREENE VALLEY DEVELOPMENTAL CENTER
City	:	GREENEVILLE
State	:	TN
Zip	:	37744-0910
Country	:	US
Telephone Number	:	423-787-6800
Fax Number	:	423-787-6574

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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