MEDICARE: CHERYL DIEDOLF 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	OTA12864	FL

General Provider Information

NPI Number	:	1477984938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL DIEDOLF COTA

Provider Business Mailing Address
First Line	:	787 37TH ST STE E110
Second Line	:	INDIAN RIVER HAND & UPPER EXTREMITY REHABILITATION
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7319
Country	:	US
Telephone Number	:	772-562-6401
Fax Number	:	772-562-6011

Provider Business Practice Location Address
First Line	:	787 37TH ST STE E110
Second Line	:	INDIAN RIVER HAND & UPPER EXTREMITY REHABILITATION
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7319
Country	:	US
Telephone Number	:	772-562-6401
Fax Number	:	772-562-6011

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

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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