MEDICARE: HEATHER NICOLE LOFTUS 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

General Provider Information

NPI Number	:	1841597622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE LOFTUS COTA/L

Provider Business Mailing Address
First Line	:	7126 BROADMORE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-3305
Country	:	US
Telephone Number	:	513-633-4737
Fax Number	:

Provider Business Practice Location Address
First Line	:	4237 SALISBURY RD STE 304
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-0908
Country	:	US
Telephone Number	:	904-281-9723
Fax Number	:

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	02/14/2011

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