MEDICARE: CHRISTOPHER PERKINS 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	17009	FL

General Provider Information

NPI Number	:	1992261150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER PERKINS COTA/L

Provider Business Mailing Address
First Line	:	1802 IRIS AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-6090
Country	:	US
Telephone Number	:	863-446-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2556
Country	:	US
Telephone Number	:	863-453-5200
Fax Number	:

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

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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