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NPI Code Detail

MEDICARE: ANGELA MARIE FOREST COTA/L

MEDICARE: ANGELA MARIE FOREST 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 Assistant2007016456MO

General Provider Information

NPI Number : 1609075522
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MARIE FOREST COTA/L
Provider Business Mailing Address
First Line : 1125 W MOUNT VERNON ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65806-1647
Country : US
Telephone Number : 417-812-0394
Fax Number :
Provider Business Practice Location Address
First Line : 410 W BENTON ST
Second Line :
City : MONETT
State : MO
Zip : 65708-1608
Country : US
Telephone Number : 417-235-3049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2007
Last Update Date : 10/12/2012

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