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NPI Code Detail

MEDICARE: WHITNEY BROOKE ROSE COTA/L

MEDICARE: WHITNEY BROOKE ROSE 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 Assistant1784TN

General Provider Information

NPI Number : 1356576086
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY BROOKE ROSE COTA/L
Provider Business Mailing Address
First Line : 1630 E REELFOOT AVE
Second Line :
City : UNION CITY
State : TN
Zip : 38261-6021
Country : US
Telephone Number : 731-885-8095
Fax Number :
Provider Business Practice Location Address
First Line : 1630 E REELFOOT AVE
Second Line :
City : UNION CITY
State : TN
Zip : 38261-6021
Country : US
Telephone Number : 731-885-8095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2009
Last Update Date : 05/26/2009

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Directions to “ WHITNEY BROOKE ROSE COTA/L” Practice Location

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