MEDICARE: LAUREN REBECCA ROTH 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	OTA006809	OH

General Provider Information

NPI Number	:	1871031971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN REBECCA ROTH COTA/L

Provider Business Mailing Address
First Line	:	8435 BRIDLE VIEW WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-2059
Country	:	US
Telephone Number	:	740-412-3780
Fax Number	:

Provider Business Practice Location Address
First Line	:	8435 BRIDLE VIEW WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-2059
Country	:	US
Telephone Number	:	740-412-3780
Fax Number	:

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	02/08/2017

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