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NPI Code Detail

MEDICARE: MRS. LEANN GAYLE KOZELISKI COTA/L

MEDICARE: MRS. LEANN GAYLE KOZELISKI 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 Assistant3257AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11051728OTHERAZCOTA CERT.

General Provider Information

NPI Number : 1942386487
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEANN GAYLE KOZELISKI COTA/L
Provider Business Mailing Address
First Line : 23801 N 35TH DR
Second Line :
City : GLENDALE
State : AZ
Zip : 85310-4169
Country : US
Telephone Number : 623-580-8526
Fax Number :
Provider Business Practice Location Address
First Line : 10251 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1305
Country : US
Telephone Number : 602-995-7366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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