MEDICARE: APRIL LEE ROBERTSON 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	0131001390	VA

General Provider Information

NPI Number	:	1528500873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL LEE ROBERTSON COTA/L

Provider Business Mailing Address
First Line	:	101 WOOD ST
Second Line	:	APT C1
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-1534
Country	:	US
Telephone Number	:	276-734-1312
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 WOOD ST
Second Line	:	APT C1
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-1534
Country	:	US
Telephone Number	:	276-734-1312
Fax Number	:

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

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	11/16/2016

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