MEDICARE: MELISSA MCCORMACK 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	OTA004572	OH

General Provider Information

NPI Number	:	1790517126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MCCORMACK COTA

Provider Business Mailing Address
First Line	:	1595 NORTHWEST BLVD APT 4
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 NORTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-2616
Country	:	US
Telephone Number	:	614-812-1200
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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