MEDICARE: JESSICA LEA WATTS 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	0131000841	VA

General Provider Information

NPI Number	:	1053726851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEA WATTS COTA/L

Provider Business Mailing Address
First Line	:	3615 W MAIN ST
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-1961
Country	:	US
Telephone Number	:	540-380-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 W MAIN ST
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-1961
Country	:	US
Telephone Number	:	540-380-5500
Fax Number	:

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	07/01/2014

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