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NPI Code Detail

MEDICARE: AMELIA JOY CRNKOVIC COTA/L

MEDICARE: AMELIA JOY CRNKOVIC 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
1224Z00000XOccupational Therapy Assistant334800LA

General Provider Information

NPI Number : 1588361927
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMELIA JOY CRNKOVIC COTA/L
Provider Business Mailing Address
First Line : 5445 HIGHWAY 2
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-8365
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5445 HIGHWAY 2
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-8365
Country : US
Telephone Number : 318-428-4025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2023
Last Update Date : 02/15/2023

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