MEDICARE: REBECCA HENAULT COTAL

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	0612	NH

General Provider Information

NPI Number	:	1548660533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA HENAULT COTAL

Provider Business Mailing Address
First Line	:	122 ROUTE 9
Second Line	:
City	:	SULLIVAN
State	:	NH
Zip	:	03445-4226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	136A ARCH ST
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-2186
Country	:	US
Telephone Number	:	603-357-3902
Fax Number	:

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

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	08/27/2014

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