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NPI Code Detail

MEDICARE: JULIE LYNN KUBIN COTA/L

MEDICARE: JULIE LYNN KUBIN 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
1224ZE0001XEnvironmental Modification Occupational Therapy AssistantOTA002098GA
2224Z00000XOccupational Therapy AssistantOTA002098GA

General Provider Information

NPI Number : 1144889510
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE LYNN KUBIN COTA/L
Provider Business Mailing Address
First Line : 3622 HURRICANE RD
Second Line :
City : ROCKY FACE
State : GA
Zip : 30740-8730
Country : US
Telephone Number : 706-581-8554
Fax Number :
Provider Business Practice Location Address
First Line : 110 PARK CITY RD
Second Line :
City : ROSSVILLE
State : GA
Zip : 30741-3980
Country : US
Telephone Number : 877-787-3422
Fax Number : 847-441-4130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2019
Last Update Date : 06/10/2019

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