MEDICARE: MRS. CYNTHIA K ALMODOVAR 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	32001485A	IN

General Provider Information

NPI Number	:	1255602611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA K ALMODOVAR COTA

Provider Business Mailing Address
First Line	:	7519 WINCHESTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2242
Country	:	US
Telephone Number	:	260-747-1101
Fax Number	:

Provider Business Practice Location Address
First Line	:	7519 WINCHESTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2242
Country	:	US
Telephone Number	:	260-747-1101
Fax Number	:

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

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	01/17/2012

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