MEDICARE: CAROL MARIE KENNY 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	02702	OH

General Provider Information

NPI Number	:	1073779369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MARIE KENNY COTA/L

Provider Business Mailing Address
First Line	:	1763 MARSHVIEW CT
Second Line	:
City	:	HEBRON
State	:	KY
Zip	:	41048-7366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8097 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-2321
Country	:	US
Telephone Number	:	513-931-5000
Fax Number	:

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

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	08/06/2008

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