MEDICARE: MRS. AVA K. LAMB-FREEMAN C.O.T.A

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	008760-1	NY

General Provider Information

NPI Number	:	1326498106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AVA K. LAMB-FREEMAN C.O.T.A

Provider Business Mailing Address
First Line	:	314 MOUNTAIN RD
Second Line	:
City	:	CORNWALL ON HUDSON
State	:	NY
Zip	:	12520-1839
Country	:	US
Telephone Number	:	631-835-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 MOUNTAIN RD
Second Line	:
City	:	CORNWALL ON HUDSON
State	:	NY
Zip	:	12520-1839
Country	:	US
Telephone Number	:	631-835-1606
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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