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NPI Code Detail

MEDICARE: MRS. AMANDA JARVIS COTA/L

MEDICARE: MRS. AMANDA JARVIS 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 AssistantOTA.06624OH

General Provider Information

NPI Number : 1639623416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA JARVIS COTA/L
Provider Business Mailing Address
First Line : 3155 LAUBERT RD
Second Line :
City : ATWATER
State : OH
Zip : 44201-9792
Country : US
Telephone Number : 330-801-0442
Fax Number :
Provider Business Practice Location Address
First Line : 507 E MAIN ST
Second Line :
City : RAVENNA
State : OH
Zip : 44266-3257
Country : US
Telephone Number : 330-296-9679
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 08/29/2016

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Directions to “ MRS. AMANDA JARVIS COTA/L” Practice Location

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