MEDICARE: ICLEIA NYARI BATES 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 12314	FL

General Provider Information

NPI Number	:	1427479286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ICLEIA NYARI BATES COTA

Provider Business Mailing Address
First Line	:	10368 PANAMA ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10368 PANAMA ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4529
Country	:	US
Telephone Number	:	954-821-3547
Fax Number	:

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

Provider Enumeration Date	:	12/21/2013
Last Update Date	:	12/21/2013

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