MEDICARE: MRS. JULIE M JOHNSON 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	60132906	WA

General Provider Information

NPI Number	:	1528542792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE M JOHNSON COTA

Provider Business Mailing Address
First Line	:	PO BOX 2196
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99210-2196
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9651 N NEVADA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-1132
Country	:	US
Telephone Number	:	509-624-3115
Fax Number	:

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

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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