MEDICARE: MRS. KATHY JANE SPECKART 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	004380	MO

General Provider Information

NPI Number	:	1679631410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY JANE SPECKART COTA L

Provider Business Mailing Address
First Line	:	11217 OAK HILL MANOR DRIVE
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-3120
Country	:	US
Telephone Number	:	314-298-0391
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 FEE FEE ROAD
Second Line	:	NNC NATIONAL HEALTHCARE MARYLAND HEIGHTS
City	:	ST LOUIS
State	:	MO
Zip	:	63043
Country	:	US
Telephone Number	:	314-291-0121
Fax Number	:	314-291-0132

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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