MEDICARE: SUSAN DAVIS SMITH 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

General Provider Information

NPI Number	:	1538591607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DAVIS SMITH COTA

Provider Business Mailing Address
First Line	:	325 VIVIAN ST
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-4840
Country	:	US
Telephone Number	:	319-329-7163
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 E PRENTICE AVE
Second Line	:	#207
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2903
Country	:	US
Telephone Number	:	303-322-8300
Fax Number	:

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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