MEDICARE: TRACY DELTORO 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	209145	TX

General Provider Information

NPI Number	:	1346508371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY DELTORO COTA

Provider Business Mailing Address
First Line	:	93 BIRCH PLACE
Second Line	:
City	:	NEW CANEY
State	:	TX
Zip	:	77357-3331
Country	:	US
Telephone Number	:	832-233-1903
Fax Number	:

Provider Business Practice Location Address
First Line	:	5177 RICHMOND AVE
Second Line	:	SUITE 750
City	:	HOUSTON
State	:	TX
Zip	:	77056-6707
Country	:	US
Telephone Number	:	832-900-2770
Fax Number	:	832-201-8489

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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