MEDICARE: GERRI LYNN SHAW 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	0131000682	VA
2	224Z00000X	Occupational Therapy Assistant	OP002853L	PA

General Provider Information

NPI Number	:	1225337116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRI LYNN SHAW COTA/L

Provider Business Mailing Address
First Line	:	9348 GILDENFIELD CT
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-5625
Country	:	US
Telephone Number	:	717-440-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	11315 CORPORATE BLVD STE 100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8340
Country	:	US
Telephone Number	:	877-896-3660
Fax Number	:	877-217-9271

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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