MEDICARE: MARK A JOHNSON 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	240953	OR

General Provider Information

NPI Number	:	1962747014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A JOHNSON COTA/L

Provider Business Mailing Address
First Line	:	25117 SW PARKWAY AVE
Second Line	:	SUITE D
City	:	WILSONVILLE
State	:	OR
Zip	:	97070-9697
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 BIRCH ST
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-1524
Country	:	US
Telephone Number	:	541-998-2395
Fax Number	:

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

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	05/29/2015

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Directions to “ MARK A JOHNSON COTA/L” Practice Location

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