MEDICARE: JUDY MCCORKLE 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	005051	OH

General Provider Information

NPI Number	:	1619377215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY MCCORKLE COTA/L

Provider Business Mailing Address
First Line	:	PO BOX 134
Second Line	:	10157 MAHONING AVE
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-0134
Country	:	US
Telephone Number	:	330-398-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	10157 MAHONING AVE
Second Line	:
City	:	NORTH JACKSON
State	:	OH
Zip	:	44451-9751
Country	:	US
Telephone Number	:	330-398-6222
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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