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NPI Code Detail

MEDICARE: MRS. ANGELA KATHRYN BLACKERBY COTA/L

MEDICARE: MRS. ANGELA KATHRYN BLACKERBY 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
1224Z00000XOccupational Therapy AssistantOTA 03124OH

General Provider Information

NPI Number : 1114168036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA KATHRYN BLACKERBY COTA/L
Provider Business Mailing Address
First Line : 4301 CLIME RD N
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-3403
Country : US
Telephone Number : 614-824-4079
Fax Number :
Provider Business Practice Location Address
First Line : 4301 CLIME RD N
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-3403
Country : US
Telephone Number : 614-824-4079
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2009
Last Update Date : 03/24/2009

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