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NPI Code Detail

MEDICARE: AMANDA WILCOX COTA/L

MEDICARE: AMANDA WILCOX COTA/L
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
1224Z00000XOccupational Therapy Assistant5785AZ

General Provider Information

NPI Number : 1376099507
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WILCOX COTA/L
Provider Business Mailing Address
First Line : 6615 W EL CORTEZ PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-1835
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6615 W EL CORTEZ PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-1835
Country : US
Telephone Number : 949-230-4074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2016
Last Update Date : 08/28/2016

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