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NPI Code Detail

MEDICARE: JORGE L TELLEZ COTA,L

MEDICARE: JORGE L TELLEZ COTA,L
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
1224Z00000XOccupational Therapy Assistant001138CT

General Provider Information

NPI Number : 1043564008
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE L TELLEZ COTA,L
Provider Business Mailing Address
First Line : 48 INDUSTRIAL PARK ACCESS RD
Second Line :
City : MIDDLEFIELD
State : CT
Zip : 06455-1263
Country : US
Telephone Number : 203-859-1182
Fax Number :
Provider Business Practice Location Address
First Line : 145 GROVE ST
Second Line :
City : WATERBURY
State : CT
Zip : 06710-2202
Country : US
Telephone Number : 203-753-7205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2012
Last Update Date : 10/30/2012

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Directions to “ JORGE L TELLEZ COTA,L” Practice Location

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