MEDICARE: RICHARD BRENT SAMMONS 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	32000304A	IN

General Provider Information

NPI Number	:	1427280437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD BRENT SAMMONS COTA

Provider Business Mailing Address
First Line	:	1911 WINDY CREEK WAY
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9667
Country	:	US
Telephone Number	:	812-246-5854
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 WINDY CREEK WAY
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9667
Country	:	US
Telephone Number	:	812-246-5854
Fax Number	:

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

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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