MEDICARE: KIMBERLY MANZANO 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

General Provider Information

NPI Number	:	1174243828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MANZANO COTA

Provider Business Mailing Address
First Line	:	1650 KANUNU ST APT 315
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-2722
Country	:	US
Telephone Number	:	808-203-7913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1677 PENSACOLA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-2676
Country	:	US
Telephone Number	:	808-537-3371
Fax Number	:

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

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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