MEDICARE: MS. LORRIE GAMMONS COTA

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	1334	NC

General Provider Information

NPI Number	:	1659540151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORRIE GAMMONS COTA

Provider Business Mailing Address
First Line	:	1300 ROBERT BROWN DR
Second Line	:
City	:	EAST BEND
State	:	NC
Zip	:	27018-8686
Country	:	US
Telephone Number	:	336-961-3462
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 W MAIN ST
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-677-1345
Fax Number	:

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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