MEDICARE: JOHN WILLIAM MILLER 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	05236	OH

General Provider Information

NPI Number	:	1154730976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILLIAM MILLER COTA/L

Provider Business Mailing Address
First Line	:	407 MORRVUE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-5244
Country	:	US
Telephone Number	:	513-515-9919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SHERMAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2510
Country	:	US
Telephone Number	:	513-631-6800
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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