MEDICARE: CHELSEA WOOD 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	212921	TX
2	224Z00000X	Occupational Therapy Assistant	OTA.0000762	CO

General Provider Information

NPI Number	:	1255787321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA WOOD COTA/L

Provider Business Mailing Address
First Line	:	153 COTTONWOOD DR
Second Line	:
City	:	FORT COBB
State	:	OK
Zip	:	73038-5860
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 COTTONWOOD DR
Second Line	:
City	:	FORT COBB
State	:	OK
Zip	:	73038-5860
Country	:	US
Telephone Number	:	940-808-9266
Fax Number	:

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

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	05/09/2016

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Directions to “ CHELSEA WOOD COTA/L” Practice Location

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