MEDICARE: ISIS MONTEAGUDO 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	12297	FL
2	225700000X	Massage Therapist	51063	FL

General Provider Information

NPI Number	:	1588007868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIS MONTEAGUDO COTA

Provider Business Mailing Address
First Line	:	6816 NW 179TH ST APT 106
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-7420
Country	:	US
Telephone Number	:	305-502-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	6816 NW 179TH ST APT 106
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-7420
Country	:	US
Telephone Number	:	305-502-8251
Fax Number	:

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

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	04/16/2013

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Directions to “ ISIS MONTEAGUDO COTA” Practice Location

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