MEDICARE: HEIDI SMALLEY 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	225X00000X	Occupational Therapist	OTA.05540	OH

General Provider Information

NPI Number	:	1932597812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI SMALLEY COTA/L

Provider Business Mailing Address
First Line	:	4067 COUNTY ROAD 6
Second Line	:
City	:	NEW RIEGEL
State	:	OH
Zip	:	44853-9757
Country	:	US
Telephone Number	:	419-934-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	4067 COUNTY ROAD 6
Second Line	:
City	:	NEW RIEGEL
State	:	OH
Zip	:	44853-9757
Country	:	US
Telephone Number	:	419-934-4336
Fax Number	:

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

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	03/02/2021

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