MEDICARE: MS. KELCEY ANN MORROW 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	000071	AZ

General Provider Information

NPI Number	:	1861143547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELCEY ANN MORROW COTA/L

Provider Business Mailing Address
First Line	:	4314 E CALLE FELIZ
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 E CALLE FELIZ
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3727
Country	:	US
Telephone Number	:	602-628-0009
Fax Number	:

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

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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