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NPI Code Detail

MEDICARE: MRS. ANGELA MARIE SURFACE COTAL

MEDICARE: MRS. ANGELA MARIE SURFACE COTAL
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
1224Z00000XOccupational Therapy AssistantC1452WV

General Provider Information

NPI Number : 1902921877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA MARIE SURFACE COTAL
Provider Business Mailing Address
First Line : PO BOX 82
Second Line :
City : LOCHGELLY
State : WV
Zip : 25866-0082
Country : US
Telephone Number : 304-465-0865
Fax Number : 304-465-8094
Provider Business Practice Location Address
First Line : 422 23RD ST
Second Line :
City : OAK HILL
State : WV
Zip : 25901-2830
Country : US
Telephone Number : 304-465-1903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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