MEDICARE: MRS. JESSICA MARIE ADCOCK 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	3390	TN

General Provider Information

NPI Number	:	1376183343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE ADCOCK COTA/L

Provider Business Mailing Address
First Line	:	2386 FALLINGWATER LN APT 304
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-7684
Country	:	US
Telephone Number	:	901-605-8530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2386 FALLINGWATER LN APT 304
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-7684
Country	:	US
Telephone Number	:	901-605-8530
Fax Number	:

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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