MEDICARE: MISS JENNA M LAWRENCE 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	OP007197	PA

General Provider Information

NPI Number	:	1063783165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNA M LAWRENCE COTA/L

Provider Business Mailing Address
First Line	:	7450 LINCOLN HWY
Second Line	:
City	:	ABBOTTSTOWN
State	:	PA
Zip	:	17301-8922
Country	:	US
Telephone Number	:	717-586-1970
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 LINCOLN HWY
Second Line	:
City	:	ABBOTTSTOWN
State	:	PA
Zip	:	17301
Country	:	US
Telephone Number	:	717-586-1970
Fax Number	:

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

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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