MEDICARE: RACHEL GOLD 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	46TA09122000	NJ
2	224Z00000X	Occupational Therapy Assistant	008939	NY

General Provider Information

NPI Number	:	1669824827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL GOLD COTA

Provider Business Mailing Address
First Line	:	20 SIENNA WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2148
Country	:	US
Telephone Number	:	732-370-9568
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 SIENNA WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2148
Country	:	US
Telephone Number	:	732-370-9568
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	03/30/2020

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