MEDICARE: MRS. WENDEE ARLEEN GROSE 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	OTA9952	FL

General Provider Information

NPI Number	:	1194917765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDEE ARLEEN GROSE COTA

Provider Business Mailing Address
First Line	:	5105 CORAL BLVD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-2114
Country	:	US
Telephone Number	:	941-792-9049
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 CORAL BLVD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-2114
Country	:	US
Telephone Number	:	941-792-9049
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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