MEDICARE: MICHAEL MADLEM COTA, LVN

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	2845	CA

General Provider Information

NPI Number	:	1700729324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MADLEM COTA, LVN

Provider Business Mailing Address
First Line	:	19957 MODOC RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-6134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19957 MODOC RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-6134
Country	:	US
Telephone Number	:	714-308-5548
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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