MEDICARE: LEAH MARTIN 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	136896	KY

General Provider Information

NPI Number	:	1528788957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MARTIN COTA/L

Provider Business Mailing Address
First Line	:	3940 SHAWNAS WAY
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-2679
Country	:	US
Telephone Number	:	859-380-1532
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 HOUSTON RD
Second Line	:
City	:	ERLANGER
State	:	KY
Zip	:	41018-3402
Country	:	US
Telephone Number	:	859-727-6700
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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