MEDICARE: MICHELE BOYD 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	001011	GA

General Provider Information

NPI Number	:	1659886257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE BOYD COTA

Provider Business Mailing Address
First Line	:	886 DESHON CREEK DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-2936
Country	:	US
Telephone Number	:	419-215-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 BOULEVARD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3352
Country	:	US
Telephone Number	:	404-688-6731
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	03/17/2018

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