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General NPI Number Information
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NPI Number | 1538408224
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Entity Type | Individual
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Provider Name | MICHAEL BRIAN LAPOLE COTA/L
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Gender | Male
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 141 S MAIN ST
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City | BOONSBORO
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State | MD
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Zip | 21713-1203
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Country | US
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Telephone | 301-432-5457
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Fax |
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Provider Business Mailing Address
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Address Line | 223 S OLLER AVE
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City | WAYNESBORO
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State | PA
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Zip | 17268-1852
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Country | US
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Telephone | 717-765-4765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | A00381
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License Number State | MD
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