MEDICARE: SHELIA BLEVINS 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	C1865	WV

General Provider Information

NPI Number	:	1174961023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELIA BLEVINS COTA/L

Provider Business Mailing Address
First Line	:	PO BOX 303
Second Line	:
City	:	SOPHIA
State	:	WV
Zip	:	25921
Country	:	US
Telephone Number	:	304-222-2960
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 LYNWINN ROAD
Second Line	:
City	:	COAL CITY
State	:	WV
Zip	:	25823
Country	:	US
Telephone Number	:	304-222-2960
Fax Number	:

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	06/12/2013

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