MEDICARE: MS. EMILY ANN LESLINE COTA

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	18-01277	KS

General Provider Information

NPI Number	:	1063181550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY ANN LESLINE COTA

Provider Business Mailing Address
First Line	:	1417 N MAIN ST
Second Line	:
City	:	MCPHERSON
State	:	KS
Zip	:	67460-1901
Country	:	US
Telephone Number	:	785-844-3173
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 N CHESTNUT ST
Second Line	:
City	:	LINDSBORG
State	:	KS
Zip	:	67456-1904
Country	:	US
Telephone Number	:	785-227-2334
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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