MEDICARE: LUCIE GARDNER 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	OTA007636	OH

General Provider Information

NPI Number	:	1598388738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIE GARDNER COTA/L

Provider Business Mailing Address
First Line	:	437 E SOUTHERN AVE
Second Line	:
City	:	BUCYRUS
State	:	OH
Zip	:	44820-3203
Country	:	US
Telephone Number	:	419-362-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3450
Country	:	US
Telephone Number	:	614-457-1100
Fax Number	:

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

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	05/22/2020

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