MEDICARE: MRS. GUERLANDE EXALIEN 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	5442	NC

General Provider Information

NPI Number	:	1639303787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GUERLANDE EXALIEN COTA

Provider Business Mailing Address
First Line	:	8816 AVEBURY DR APT C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-3161
Country	:	US
Telephone Number	:	919-630-3602
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3214
Country	:	US
Telephone Number	:	919-630-3563
Fax Number	:

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

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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