MEDICARE: BREANNA CAROL STRASESKE 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	OTA-046993	AZ

General Provider Information

NPI Number	:	1568238152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA CAROL STRASESKE COTA

Provider Business Mailing Address
First Line	:	20245 N 32ND DR APT 277
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-0311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 E INDIAN SCHOOL RD # 277
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4929
Country	:	US
Telephone Number	:	608-443-6054
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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Directions to “ BREANNA CAROL STRASESKE COTA” Practice Location

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