MEDICARE: CHEVALA C SCRUGGS 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	OTA.04117	OH

General Provider Information

NPI Number	:	1225354780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEVALA C SCRUGGS COTA/L

Provider Business Mailing Address
First Line	:	6000 TURKEY LAKE RD STE 114
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4205
Country	:	US
Telephone Number	:	321-368-2172
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 TURKEY LAKE RD STE 114
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4205
Country	:	US
Telephone Number	:	321-368-2172
Fax Number	:

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

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	08/08/2022

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