MEDICARE: SARAH KATHERINE MACKAY COTA

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	213991	TX

General Provider Information

NPI Number	:	1013499755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KATHERINE MACKAY COTA

Provider Business Mailing Address
First Line	:	12222 VANCE JACKSON RD APT 1112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5943
Country	:	US
Telephone Number	:	210-818-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	11124 WURZBACH RD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2445
Country	:	US
Telephone Number	:	210-615-5242
Fax Number	:

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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