MEDICARE: MS. JESSICA JANET GAMBLE 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	OP000854L	PA

General Provider Information

NPI Number	:	1710199419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA JANET GAMBLE COTA

Provider Business Mailing Address
First Line	:	1756 CHESTNUT ST
Second Line	:
City	:	NEW RINGGOLD
State	:	PA
Zip	:	17960-9561
Country	:	US
Telephone Number	:	570-366-1941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 CHESTNUT ST
Second Line	:
City	:	NEW RINGGOLD
State	:	PA
Zip	:	17960-9561
Country	:	US
Telephone Number	:	570-366-1941
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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