MEDICARE: HANNAH KELLISON 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	2014009870	MO

General Provider Information

NPI Number	:	1952709222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH KELLISON COTA/L

Provider Business Mailing Address
First Line	:	27405 STEER CREEK WAY
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-7210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR1 BOX 212
Second Line	:	SCHUYLER COUNTY NURSING HOME
City	:	QUEEN CITY
State	:	MO
Zip	:	63561
Country	:	US
Telephone Number	:	660-766-2291
Fax Number	:

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

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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