MEDICARE: MR. JOSEPH DANIEL BRYANT 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		VA

General Provider Information

NPI Number	:	1639310378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH DANIEL BRYANT COTA

Provider Business Mailing Address
First Line	:	324 T B STANLEY HWY
Second Line	:	SUITE F
City	:	BASSETT
State	:	VA
Zip	:	24055-6108
Country	:	US
Telephone Number	:	276-627-8660
Fax Number	:	276-627-8661

Provider Business Practice Location Address
First Line	:	324 T B STANLEY HWY
Second Line	:	SUITE F
City	:	BASSETT
State	:	VA
Zip	:	24055-6108
Country	:	US
Telephone Number	:	276-627-8660
Fax Number	:	276-627-8661

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/10/2009

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