MEDICARE: KAYLA MARIE LANKEY COTA

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	4146	TN

General Provider Information

NPI Number	:	1104664929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MARIE LANKEY COTA

Provider Business Mailing Address
First Line	:	90 HOWARD DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8138
Country	:	US
Telephone Number	:	502-633-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 HICKORY CREEK RD
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-6975
Country	:	US
Telephone Number	:	423-453-7319
Fax Number	:

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

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	08/05/2024

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