MEDICARE: MRS. TINA L CLAYTON 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	6368	NC

General Provider Information

NPI Number	:	1609995851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA L CLAYTON COTA

Provider Business Mailing Address
First Line	:	430 WOODLAND AVE
Second Line	:
City	:	INMAN
State	:	SC
Zip	:	29349-8605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 LAUREL LAKE DR
Second Line	:
City	:	COLUMBUS
State	:	NC
Zip	:	28722-7451
Country	:	US
Telephone Number	:	828-894-3895
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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