MEDICARE: ASHLEY ELIZABETH BEVAN 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	OP006417	PA

General Provider Information

NPI Number	:	1396020889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELIZABETH BEVAN COTA/L

Provider Business Mailing Address
First Line	:	1602 KANSAS AVE
Second Line	:	1ST FLOOR
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2130
Country	:	US
Telephone Number	:	412-302-7542
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 KANSAS AVE
Second Line	:	1ST FLOOR
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2130
Country	:	US
Telephone Number	:	412-302-7542
Fax Number	:

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

Provider Enumeration Date	:	10/15/2011
Last Update Date	:	10/15/2011

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