MEDICARE: MS. NANCY CARR 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	1206	CA

General Provider Information

NPI Number	:	1366832792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY CARR COTA

Provider Business Mailing Address
First Line	:	6071 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-3503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 YORK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-3503
Country	:	US
Telephone Number	:	323-254-3407
Fax Number	:

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

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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