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NPI Code Detail

MEDICARE: JENNIFER SHEA COTA/L

MEDICARE: JENNIFER SHEA 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
1224Z00000XOccupational Therapy Assistant0131000912VA

General Provider Information

NPI Number : 1932516200
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER SHEA COTA/L
Provider Business Mailing Address
First Line : 5520 INDIAN RIVER RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-5217
Country : US
Telephone Number : 757-420-3600
Fax Number :
Provider Business Practice Location Address
First Line : 5520 INDIAN RIVER RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-5217
Country : US
Telephone Number : 757-420-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2014
Last Update Date : 07/17/2014

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Directions to “ JENNIFER SHEA COTA/L” Practice Location

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