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NPI Code Detail

MEDICARE: TYLER EARL COTA/L

MEDICARE: TYLER EARL 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
1224Z00000XOccupational Therapy AssistantOTA-1278ID

General Provider Information

NPI Number : 1033654900
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER EARL COTA/L
Provider Business Mailing Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number :
Provider Business Practice Location Address
First Line : 2303 PARK AVE
Second Line :
City : BURLEY
State : ID
Zip : 83318-2106
Country : US
Telephone Number : 208-677-3073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2016
Last Update Date : 12/30/2016

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Directions to “ TYLER EARL COTA/L” Practice Location

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