MEDICARE: KERRY KOTT L.AC.

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	171100000X	Acupuncturist	AP 2983	FL

General Provider Information

NPI Number	:	1649566670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY KOTT L.AC.

Provider Business Mailing Address
First Line	:	28618 S RABER RD
Second Line	:
City	:	GOETZVILLE
State	:	MI
Zip	:	49736-9364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	SUITE J
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-833-2299
Fax Number	:

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	08/31/2021

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