MEDICARE: MRS. SUSAN JOY GREEN 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	256	NE

General Provider Information

NPI Number	:	1134407091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN JOY GREEN COTA/L

Provider Business Mailing Address
First Line	:	22714 COUNTY ROAD 26
Second Line	:
City	:	ARLINGTON
State	:	NE
Zip	:	68002-5042
Country	:	US
Telephone Number	:	402-478-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	22714 COUNTY ROAD 26
Second Line	:
City	:	ARLINGTON
State	:	NE
Zip	:	68002-5042
Country	:	US
Telephone Number	:	402-478-5540
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	07/26/2011

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