MEDICARE: MRS. KATHY L. BRITE 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	224ZR0403X	Driving and Community Mobility Occupational Therapy Assistant	2007018378	MO

General Provider Information

NPI Number	:	1881905099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY L. BRITE COTA/L

Provider Business Mailing Address
First Line	:	406 NORTHVIEW CIR E
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-8426
Country	:	US
Telephone Number	:	417-759-6354
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 NORTHVIEW CIR E
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-8426
Country	:	US
Telephone Number	:	417-759-6354
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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