MEDICARE: SHANNON LEA HIGGS COTAL

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	A00812	MD

General Provider Information

NPI Number	:	1124143029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEA HIGGS COTAL

Provider Business Mailing Address
First Line	:	644 BARLOW RD
Second Line	:
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-8650
Country	:	US
Telephone Number	:	717-337-2707
Fax Number	:	301-607-1017

Provider Business Practice Location Address
First Line	:	1900 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-8249
Country	:	US
Telephone Number	:	301-600-3708
Fax Number	:	301-607-1017

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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