MEDICARE: JENNIFER LEE MALONE 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	913	OK

General Provider Information

NPI Number	:	1043321045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEE MALONE COTA

Provider Business Mailing Address
First Line	:	PO BOX 14577
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73113-0577
Country	:	US
Telephone Number	:	405-840-3774
Fax Number	:	580-795-7307

Provider Business Practice Location Address
First Line	:	6400 N SANTA FE AVE
Second Line	:	STE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-9126
Country	:	US
Telephone Number	:	405-840-2903
Fax Number	:	405-840-3256

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/25/2007

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