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NPI Code Detail

MEDICARE: MR. ROBERT LEE CARLSON COTA/L

MEDICARE: MR. ROBERT LEE CARLSON 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 AssistantOTA 01543OH

General Provider Information

NPI Number : 1376793109
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT LEE CARLSON COTA/L
Provider Business Mailing Address
First Line : 644 BOBWHITE TRL
Second Line :
City : AKRON
State : OH
Zip : 44319-3889
Country : US
Telephone Number : 330-289-5908
Fax Number :
Provider Business Practice Location Address
First Line : 330 BROADWAY ST E
Second Line :
City : CUYAHOGA FALLS
State : OH
Zip : 44221-3312
Country : US
Telephone Number : 330-945-9797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2008
Last Update Date : 09/29/2008

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