MEDICARE: MRS. SARA MARIE CASEY COTAL

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	03631	OH

General Provider Information

NPI Number	:	1043439177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA MARIE CASEY COTAL

Provider Business Mailing Address
First Line	:	236 BIG ROCK RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45431-1843
Country	:	US
Telephone Number	:	937-781-9345
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 BIG ROCK RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45431-1843
Country	:	US
Telephone Number	:	937-781-9345
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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