MEDICARE: MRS. TERESA JEAN COBB OTR

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	225X00000X	Occupational Therapist	003113	MO

General Provider Information

NPI Number	:	1326108382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA JEAN COBB OTR

Provider Business Mailing Address
First Line	:	112 N BERKLEY ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1202
Country	:	US
Telephone Number	:	573-264-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 N BERKLEY ST
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-1202
Country	:	US
Telephone Number	:	573-264-3477
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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