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NPI Code Detail

MEDICARE: MISS BIANCA I GRAYER COTA-L

MEDICARE: MISS BIANCA I GRAYER 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 AssistantOTA13426FL

General Provider Information

NPI Number : 1508583030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS BIANCA I GRAYER COTA-L
Provider Business Mailing Address
First Line : 2600 COMPASS RD
Second Line :
City : GLENVIEW
State : IL
Zip : 60026-8001
Country : US
Telephone Number : 877-787-3430
Fax Number :
Provider Business Practice Location Address
First Line : 9601 SOUTHBROOK DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-0601
Country : US
Telephone Number : 904-641-7501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2022
Last Update Date : 10/25/2022

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Directions to “ MISS BIANCA I GRAYER COTA-L” Practice Location

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