MEDICARE: LIDIA LOPEZ 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	6811	AZ

General Provider Information

NPI Number	:	1518436534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDIA LOPEZ COTA

Provider Business Mailing Address
First Line	:	1017 W ELNA RAE ST
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-5337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 W ELNA RAE ST
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-5337
Country	:	US
Telephone Number	:	928-581-4490
Fax Number	:

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

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	11/20/2018

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Directions to “ LIDIA LOPEZ COTA” Practice Location

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