MEDICARE: MS. CASSANDRA WOOD 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	210288	TX

General Provider Information

NPI Number	:	1437600673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSANDRA WOOD COTA

Provider Business Mailing Address
First Line	:	725 ANDERSON COUNTY RD 1200
Second Line	:
City	:	ELKHART
State	:	TX
Zip	:	75839
Country	:	US
Telephone Number	:	903-922-3610
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W LANCASTER AVE
Second Line	:	UNIT 210
City	:	FORT WORTH
State	:	TX
Zip	:	76102-6663
Country	:	US
Telephone Number	:	903-922-3601
Fax Number	:

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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