MEDICARE: ROUWAIDA MOHAMED HAMADA 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	010453	NY

General Provider Information

NPI Number	:	1033742408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROUWAIDA MOHAMED HAMADA COTA

Provider Business Mailing Address
First Line	:	433 ATLANTIC AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 ATLANTIC AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2335
Country	:	US
Telephone Number	:	347-445-4731
Fax Number	:

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

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/13/2020

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