MEDICARE: GALE M SHOOK 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

General Provider Information

NPI Number	:	1699802264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALE M SHOOK COTA

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:	610-991-2034
Fax Number	:	610-438-2046

Provider Business Practice Location Address
First Line	:	175 W NORTH ST
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064-1410
Country	:	US
Telephone Number	:	610-991-2034
Fax Number	:	610-438-2046

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/09/2007

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