MEDICARE: KATIE CONSTANTINE 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	314000000X	Skilled Nursing Facility	15657	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	806032791	OTHER	FL	TEAMCARE

General Provider Information

NPI Number	:	1205373040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE CONSTANTINE COTA

Provider Business Mailing Address
First Line	:	3502 SW 6TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1607
Country	:	US
Telephone Number	:	239-699-1035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 SW 6TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1607
Country	:	US
Telephone Number	:	239-699-1035
Fax Number	:

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

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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Directions to “ KATIE CONSTANTINE COTA” Practice Location

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