MEDICARE: MS. KAYLA RENEE BROWN 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

General Provider Information

NPI Number	:	1063663144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYLA RENEE BROWN COTA/L

Provider Business Mailing Address
First Line	:	3261 S PALISADES DR
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-8501
Country	:	US
Telephone Number	:	417-343-5910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 N GLENSTONE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-2130
Country	:	US
Telephone Number	:	417-864-4100
Fax Number	:	417-863-8697

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

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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