MEDICARE: MELISSA ANGLEBERGER 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	A02315	MD

General Provider Information

NPI Number	:	1568936375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANGLEBERGER COTA/L

Provider Business Mailing Address
First Line	:	9229 GRAVEL HILL RD
Second Line	:
City	:	WOODSBORO
State	:	MD
Zip	:	21798-8817
Country	:	US
Telephone Number	:	301-639-4012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-8249
Country	:	US
Telephone Number	:	240-772-9200
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	11/19/2019

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