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NPI Code Detail

MEDICARE: MR. MATTHEW MICHAEL BAILEY COTA/L

MEDICARE: MR. MATTHEW MICHAEL BAILEY 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 Assistant5202008415MI

General Provider Information

NPI Number : 1396228003
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW MICHAEL BAILEY COTA/L
Provider Business Mailing Address
First Line : 5690 FOREST VIEW ST
Second Line :
City : ALLENDALE
State : MI
Zip : 49401-9325
Country : US
Telephone Number : 616-540-4738
Fax Number :
Provider Business Practice Location Address
First Line : 900 S BEACON BLVD
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-2146
Country : US
Telephone Number : 616-846-1850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2018
Last Update Date : 09/09/2018

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