MEDICARE: MS. YADIRA LANDA 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	OTA-050138	AZ

General Provider Information

NPI Number	:	1013802750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YADIRA LANDA COTA

Provider Business Mailing Address
First Line	:	PO BOX 8372
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-6827
Country	:	US
Telephone Number	:	928-285-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1938 E JUAN SANCHEZ BLVD STE 1
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85336-0478
Country	:	US
Telephone Number	:	928-285-4343
Fax Number	:

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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