MEDICARE: KELLEY-BETH TRACY 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	5202008394	MI

General Provider Information

NPI Number	:	1346017266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY-BETH TRACY COTA/L

Provider Business Mailing Address
First Line	:	216 HARRISON ST APT 103
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-1068
Country	:	US
Telephone Number	:	734-395-2969
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 W COMMERCE RD
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-3100
Country	:	US
Telephone Number	:	248-685-1400
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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