MEDICARE: MRS. APRIL MARIA DEVEREAUX 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	C1788	WV

General Provider Information

NPI Number	:	1548559040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. APRIL MARIA DEVEREAUX COTA/L

Provider Business Mailing Address
First Line	:	124 OAKDALE ST
Second Line	:
City	:	MOUNT HOPE
State	:	WV
Zip	:	25880-9219
Country	:	US
Telephone Number	:	240-727-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 OAKDALE ST
Second Line	:
City	:	MOUNT HOPE
State	:	WV
Zip	:	25880-9219
Country	:	US
Telephone Number	:	240-727-1808
Fax Number	:

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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