MEDICARE: LYNDSIE PATRICIA MOST-GEPHART COTA

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	057.005788	IL

General Provider Information

NPI Number	:	1508503996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDSIE PATRICIA MOST-GEPHART COTA

Provider Business Mailing Address
First Line	:	11 HOMEWOOD CT
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4874
Country	:	US
Telephone Number	:	217-280-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 GREENHEAD DR STE D
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7426
Country	:	US
Telephone Number	:	217-891-1524
Fax Number	:

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

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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