MEDICARE: MELISSA EILEEN SUERMANN 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	057005366	IL

General Provider Information

NPI Number	:	1093314593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA EILEEN SUERMANN COTA/L

Provider Business Mailing Address
First Line	:	445 E 3RD ST
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-2410
Country	:	US
Telephone Number	:	618-792-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S STATION RD
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-2739
Country	:	US
Telephone Number	:	618-288-5014
Fax Number	:

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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