MEDICARE: HEATHER R MAXWELL 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	OTA. 02853	OH

General Provider Information

NPI Number	:	1801116587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER R MAXWELL COTA/L

Provider Business Mailing Address
First Line	:	5615 PLEASANT VIEW DR
Second Line	:
City	:	NASHPORT
State	:	OH
Zip	:	43830-9058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	339 E MAPLE ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2593
Country	:	US
Telephone Number	:	330-498-8200
Fax Number	:

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

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	06/04/2010

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