MEDICARE: NATHAN CONNOLLY 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	003940	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003940	OTHER	OH	OHIO OT PT AT BOARD

General Provider Information

NPI Number	:	1033682216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN CONNOLLY COTA

Provider Business Mailing Address
First Line	:	33 CROSS ST
Second Line	:
City	:	JACKSON
State	:	OH
Zip	:	45640-1511
Country	:	US
Telephone Number	:	740-339-9807
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 COLUMBUS CIR
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-1370
Country	:	US
Telephone Number	:	740-592-1000
Fax Number	:

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

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	01/09/2019

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