MEDICARE: MS. JENNIFER WALKER 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	OTA-07158	OH

General Provider Information

NPI Number	:	1578724167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER WALKER COTA/L

Provider Business Mailing Address
First Line	:	4109 E 175TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 E 175TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2223
Country	:	US
Telephone Number	:	216-410-5512
Fax Number	:

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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