MEDICARE: MRS. MARY CATHERINE DEWITT 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	OTA02969	OH

General Provider Information

NPI Number	:	1801083936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CATHERINE DEWITT COTA/L

Provider Business Mailing Address
First Line	:	4559 LOTUS DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45427-3537
Country	:	US
Telephone Number	:	937-263-5338
Fax Number	:

Provider Business Practice Location Address
First Line	:	4559 LOTUS DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45427-3537
Country	:	US
Telephone Number	:	937-263-5338
Fax Number	:

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

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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