MEDICARE: MISS NATASHA REBECCA KEVER C.O.T.A.

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	32001301A	IN
2	224Z00000X	Occupational Therapy Assistant	6450	NC

General Provider Information

NPI Number	:	1649499575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATASHA REBECCA KEVER C.O.T.A.

Provider Business Mailing Address
First Line	:	2424 S HARRISON ST
Second Line	:	APT #2
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 S HARRISON ST
Second Line	:	APT #2
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1316
Country	:	US
Telephone Number	:	260-715-7783
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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