MEDICARE: MEGAN MICHELLE BOATMAN 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	085143	IA

General Provider Information

NPI Number	:	1285178004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MICHELLE BOATMAN COTA/L

Provider Business Mailing Address
First Line	:	26183 REDBUD AVE
Second Line	:
City	:	BONAPARTE
State	:	IA
Zip	:	52620-8116
Country	:	US
Telephone Number	:	641-799-3720
Fax Number	:

Provider Business Practice Location Address
First Line	:	26183 REDBUD AVE
Second Line	:
City	:	BONAPARTE
State	:	IA
Zip	:	52620-8116
Country	:	US
Telephone Number	:	641-799-3720
Fax Number	:

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	12/13/2016

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