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NPI Code Detail

MEDICARE: MR. JACOB BAILEY COTA/L

MEDICARE: MR. JACOB 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 AssistantC2501WV

General Provider Information

NPI Number : 1528817368
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACOB BAILEY COTA/L
Provider Business Mailing Address
First Line : 1769 ROBERT C BYRD DR
Second Line :
City : BECKLEY
State : WV
Zip : 25801-8707
Country : US
Telephone Number : 304-860-1048
Fax Number :
Provider Business Practice Location Address
First Line : 1769 ROBERT C BYRD DR
Second Line :
City : BECKLEY
State : WV
Zip : 25801-8707
Country : US
Telephone Number : 304-860-1048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2024
Last Update Date : 05/15/2024

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Directions to “ MR. JACOB BAILEY COTA/L” Practice Location

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