MEDICARE: JENNIFER BLOOM 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	02396	OH

General Provider Information

NPI Number	:	1083038509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BLOOM COTA

Provider Business Mailing Address
First Line	:	2321 W 16TH ST
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-2421
Country	:	US
Telephone Number	:	440-812-1626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 W PROSPECT RD
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-6439
Country	:	US
Telephone Number	:	440-998-7505
Fax Number	:

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	08/26/2020

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Directions to “ JENNIFER BLOOM COTA” Practice Location

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