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NPI Code Detail

MEDICARE: JAY MATTHEW TOWLER COTA

MEDICARE: JAY MATTHEW TOWLER 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
1224Z00000XOccupational Therapy Assistant2015TN

General Provider Information

NPI Number : 1063750388
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY MATTHEW TOWLER COTA
Provider Business Mailing Address
First Line : 1361 OLD HOPKINSVILLE RD
Second Line :
City : CADIZ
State : KY
Zip : 42211-9729
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1630 E REELFOOT AVE
Second Line :
City : UNION CITY
State : TN
Zip : 38261-6021
Country : US
Telephone Number : 731-885-8095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2013
Last Update Date : 01/21/2013

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