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NPI Code Detail

MEDICARE: JACQUELYN RITCHIE COTA/L

MEDICARE: JACQUELYN RITCHIE 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 Assistant2018012945MO

General Provider Information

NPI Number : 1407554272
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN RITCHIE COTA/L
Provider Business Mailing Address
First Line : 1090 E 13TH ST
Second Line :
City : CASSVILLE
State : MO
Zip : 65625-2010
Country : US
Telephone Number : 417-342-8148
Fax Number :
Provider Business Practice Location Address
First Line : 1700 S HUDSON AVE
Second Line :
City : AURORA
State : MO
Zip : 65605-2717
Country : US
Telephone Number : 417-678-2165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 02/21/2023

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Directions to “ JACQUELYN RITCHIE COTA/L” Practice Location

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