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NPI Code Detail

MEDICARE: EMILIE I. CLARK COTAL

MEDICARE: EMILIE I. CLARK COTAL
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 AssistantOTA01904OH
2224Z00000XOccupational Therapy AssistantC1276WV
3224Z00000XOccupational Therapy AssistantOP002386LPA

General Provider Information

NPI Number : 1780732487
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILIE I. CLARK COTAL
Provider Business Mailing Address
First Line : 4697 HARRISON ST
Second Line :
City : BELLAIRE
State : OH
Zip : 43906-1338
Country : US
Telephone Number : 740-671-1436
Fax Number : 740-671-1210
Provider Business Practice Location Address
First Line : 4697 HARRISON ST
Second Line :
City : BELLAIRE
State : OH
Zip : 43906-1338
Country : US
Telephone Number : 740-671-1436
Fax Number : 740-671-1210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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Directions to “ EMILIE I. CLARK COTAL” Practice Location

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