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NPI Code Detail

MEDICARE: VICKIE MARIE HART-PETERSON COTA/L

MEDICARE: VICKIE MARIE HART-PETERSON 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
1224Z00000XOccupational Therapy Assistant005130MO

General Provider Information

NPI Number : 1316147044
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKIE MARIE HART-PETERSON COTA/L
Provider Business Mailing Address
First Line : 11900 JESSICA LN
Second Line :
City : RAYTOWN
State : MO
Zip : 64138-2649
Country : US
Telephone Number : 816-358-7858
Fax Number :
Provider Business Practice Location Address
First Line : 11900 JESSICA LN
Second Line :
City : RAYTOWN
State : MO
Zip : 64138-2649
Country : US
Telephone Number : 816-358-7858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2007
Last Update Date : 05/25/2010

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