MEDICARE: MR. RAYMOND NEIL WEBER 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	OTA12051	FL

General Provider Information

NPI Number	:	1437423944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND NEIL WEBER COTA

Provider Business Mailing Address
First Line	:	6060 N CENTRAL EXPY
Second Line	:	SUITE 460
City	:	DALLAS
State	:	TX
Zip	:	75206-5209
Country	:	US
Telephone Number	:	214-414-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 MATTIE KELLY BLVD
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2811
Country	:	US
Telephone Number	:	214-414-2888
Fax Number	:

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

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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