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NPI Code Detail

MEDICARE: JENNIFER MCGOVERN COTA/L

MEDICARE: JENNIFER MCGOVERN 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 Assistant9151NC

General Provider Information

NPI Number : 1295139657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MCGOVERN COTA/L
Provider Business Mailing Address
First Line : 107 RIBBON LANE
Second Line : APT R
City : CARY
State : NC
Zip : 27518
Country : US
Telephone Number : 850-556-2707
Fax Number :
Provider Business Practice Location Address
First Line : 900 W DOLPHIN ST
Second Line :
City : SILER CITY
State : NC
Zip : 27344-3711
Country : US
Telephone Number : 919-663-3431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2014
Last Update Date : 10/14/2014

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