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NPI Code Detail

MEDICARE: MRS. NICOLE RENEE BRADSHAW COTA/L

MEDICARE: MRS. NICOLE RENEE BRADSHAW 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 Assistant02256OH

General Provider Information

NPI Number : 1174096416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE RENEE BRADSHAW COTA/L
Provider Business Mailing Address
First Line : 422 SHERIDAN ST
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-2556
Country : US
Telephone Number : 740-503-9883
Fax Number :
Provider Business Practice Location Address
First Line : 717 NEIL AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-1609
Country : US
Telephone Number : 614-228-8888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2019
Last Update Date : 01/22/2019

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