MEDICARE: MS. AMBER BACON 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	OTA008299	OH

General Provider Information

NPI Number	:	1386323798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBER BACON COTA/L

Provider Business Mailing Address
First Line	:	997 HILO LN
Second Line	:
City	:	GRANDVIEW HEIGHTS
State	:	OH
Zip	:	43212-3625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	997 HILO LN
Second Line	:
City	:	GRANDVIEW HEIGHTS
State	:	OH
Zip	:	43212-3625
Country	:	US
Telephone Number	:	614-325-5185
Fax Number	:

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

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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