MEDICARE: CANDICE MARIE ROSENBOHM 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	OTA.0001340	CO

General Provider Information

NPI Number	:	1376156406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MARIE ROSENBOHM COTA

Provider Business Mailing Address
First Line	:	1069 MILANO PT APT 1624
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-5668
Country	:	US
Telephone Number	:	309-642-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1069 MILANO PT APT 1624
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-5668
Country	:	US
Telephone Number	:	309-642-7904
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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