MEDICARE: JENNIFER FILE C.O.T.A./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	OTA000981	GA
2	224Z00000X	Occupational Therapy Assistant	OTA 13585	FL

General Provider Information

NPI Number	:	1215217146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FILE C.O.T.A./L

Provider Business Mailing Address
First Line	:	12105 NORTHLAKE HEIGHTS CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2285
Country	:	US
Telephone Number	:	843-822-0768
Fax Number	:

Provider Business Practice Location Address
First Line	:	12105 NORTHLAKE HEIGHTS CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2285
Country	:	US
Telephone Number	:	843-822-0768
Fax Number	:

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

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/06/2020

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