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NPI Code Detail

MEDICARE: ANDREA LYNN KRAUSE COTA/L, A.D

MEDICARE:   ANDREA LYNN KRAUSE  COTA/L, A.D
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 Assistant5202006626MI

General Provider Information

NPI Number : 1629792544
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LYNN KRAUSE COTA/L, A.D
Provider Business Mailing Address
First Line : 419 LIBERTY ST
Second Line :
City : PETOSKEY
State : MI
Zip : 49770-2342
Country : US
Telephone Number : 231-489-5062
Fax Number :
Provider Business Practice Location Address
First Line : 750 E MAIN ST
Second Line :
City : HARBOR SPRINGS
State : MI
Zip : 49740-1548
Country : US
Telephone Number : 231-526-4900
Fax Number : 231-526-5252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2022
Last Update Date : 10/04/2022

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Directions to “ ANDREA LYNN KRAUSE COTA/L, A.D” Practice Location

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