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NPI Code Detail

MEDICARE: MRS. LISA MARIE MCDANIEL COTA.L

MEDICARE: MRS. LISA MARIE MCDANIEL 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 Assistant03496OH

General Provider Information

NPI Number : 1629190608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA MARIE MCDANIEL COTA.L
Provider Business Mailing Address
First Line : 2901 ARGELLA AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-3152
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1390 KING TREE DR
Second Line :
City : DAYTON
State : OH
Zip : 45405-1401
Country : US
Telephone Number : 937-278-0723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/08/2007

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