MEDICARE: KRISTY M. PERKINS 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	0131000299	VA

General Provider Information

NPI Number	:	1205181476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY M. PERKINS COTA/L

Provider Business Mailing Address
First Line	:	1203 LOCUST AVE
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-1509
Country	:	US
Telephone Number	:	434-610-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 LOCUST AVE
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-1509
Country	:	US
Telephone Number	:	434-610-8222
Fax Number	:

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

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/13/2012

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