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NPI Code Detail

MEDICARE: MRS. AMY BRENNAN TKACZYK COTA/L

MEDICARE: MRS. AMY BRENNAN TKACZYK 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 Assistant0464NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780298216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY BRENNAN TKACZYK COTA/L
Provider Business Mailing Address
First Line : 30 MILL POND RD
Second Line :
City : NORTHWOOD
State : NH
Zip : 03261-3240
Country : US
Telephone Number : 603-608-9929
Fax Number :
Provider Business Practice Location Address
First Line : 22 ROLLER COASTER RD
Second Line :
City : STRAFFORD
State : NH
Zip : 03884-6648
Country : US
Telephone Number : 603-664-2842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 09/02/2020

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