MEDICARE: TRACI JONES 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	5202007005	MI

General Provider Information

NPI Number	:	1790532554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI JONES COTA/L

Provider Business Mailing Address
First Line	:	1351 BEMIS ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-2546
Country	:	US
Telephone Number	:	616-635-6591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 DAVIS AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3112
Country	:	US
Telephone Number	:	616-819-2565
Fax Number	:

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

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “ TRACI JONES COTA/L” Practice Location

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