MEDICARE: KARA WALLS 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	2485	TN

General Provider Information

NPI Number	:	1225501141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA WALLS COTA

Provider Business Mailing Address
First Line	:	1097 MIDDLE RD
Second Line	:
City	:	MILAN
State	:	TN
Zip	:	38358-5557
Country	:	US
Telephone Number	:	731-414-3349
Fax Number	:

Provider Business Practice Location Address
First Line	:	897 EVERGREEN ST
Second Line	:
City	:	DRESDEN
State	:	TN
Zip	:	38225-2305
Country	:	US
Telephone Number	:	731-364-2450
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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