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NPI Code Detail

MEDICARE: DAJUAN WESLEY CARPENTER COTA

MEDICARE: DAJUAN WESLEY CARPENTER 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
1224Z00000XOccupational Therapy Assistant

General Provider Information

NPI Number : 1679218283
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAJUAN WESLEY CARPENTER COTA
Provider Business Mailing Address
First Line : 182 MICHIGAN AVE # B
Second Line :
City : WILMINGTON
State : OH
Zip : 45177-1327
Country : US
Telephone Number : 614-425-9495
Fax Number :
Provider Business Practice Location Address
First Line : 5070 LAMME RD
Second Line :
City : MORAINE
State : OH
Zip : 45439-3266
Country : US
Telephone Number : 937-293-7703
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2022
Last Update Date : 04/28/2022

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