MEDICARE: JESSICA M LEHR COTA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	434501	OTHER		NBCOT

General Provider Information

NPI Number	:	1174156780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M LEHR COTA

Provider Business Mailing Address
First Line	:	1001 E 8TH ST UNIT 4008
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-7467
Country	:	US
Telephone Number	:	585-261-2966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 S GILBERT RD STE 111
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6000
Country	:	US
Telephone Number	:	480-401-2527
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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