MEDICARE: COURTNEY WIATER 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	OP008404	PA

General Provider Information

NPI Number	:	1790453231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY WIATER COTA/L

Provider Business Mailing Address
First Line	:	1439 SHIRLEY LN
Second Line	:
City	:	PERKASIE
State	:	PA
Zip	:	18944-2868
Country	:	US
Telephone Number	:	215-760-5974
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MAPLE AVE
Second Line	:
City	:	HARLEYSVILLE
State	:	PA
Zip	:	19438-1032
Country	:	US
Telephone Number	:	215-256-9501
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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