MEDICARE: ERIN NICOLE BAILEY 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	224ZE0001X	Environmental Modification Occupational Therapy Assistant	057.004595	IL

General Provider Information

NPI Number	:	1700343563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN NICOLE BAILEY COTA/L

Provider Business Mailing Address
First Line	:	202 N CHURCH ST
Second Line	:
City	:	PITTSBURG
State	:	IL
Zip	:	62974-1110
Country	:	US
Telephone Number	:	618-841-5272
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 N CHURCH ST
Second Line	:
City	:	PITTSBURG
State	:	IL
Zip	:	62974-1110
Country	:	US
Telephone Number	:	618-841-5272
Fax Number	:

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

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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