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NPI Code Detail

MEDICARE: MRS. REBECCA LEE SHORES MASEK COTA/L

MEDICARE: MRS. REBECCA LEE SHORES MASEK 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 AssistantKY-A5571KY

General Provider Information

NPI Number : 1598995516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA LEE SHORES MASEK COTA/L
Provider Business Mailing Address
First Line : 201 KIMBERLY LN
Second Line :
City : WILLIAMSTOWN
State : KY
Zip : 41097-9458
Country : US
Telephone Number : 859-824-7803
Fax Number :
Provider Business Practice Location Address
First Line : 201 KIMBERLY LN
Second Line :
City : WILLIAMSTOWN
State : KY
Zip : 41097-9458
Country : US
Telephone Number : 859-824-7803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2009
Last Update Date : 04/01/2015

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