MEDICARE: MERILEE WALKER 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
1	224Z00000X	Occupational Therapy Assistant	2260	NM

General Provider Information

NPI Number	:	1841456241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERILEE WALKER COTA/L

Provider Business Mailing Address
First Line	:	1118 9TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4037
Country	:	US
Telephone Number	:	505-426-7466
Fax Number	:	505-425-7196

Provider Business Practice Location Address
First Line	:	1118 9TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4037
Country	:	US
Telephone Number	:	505-426-7466
Fax Number	:	505-425-7196

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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Directions to “ MERILEE WALKER COTA/L” Practice Location

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