MEDICARE: MS. TRACEY LEE NOBLE 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	OTA633	FL

General Provider Information

NPI Number	:	1821425810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEY LEE NOBLE COTA/L

Provider Business Mailing Address
First Line	:	11116 CLAYRIDGE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1547
Country	:	US
Telephone Number	:	813-401-1830
Fax Number	:	813-854-5965

Provider Business Practice Location Address
First Line	:	2851 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3314
Country	:	US
Telephone Number	:	727-789-8605
Fax Number	:

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

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	10/04/2013

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