MEDICARE: MARIA NINEL CORTEZ PARKER 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	15507	NC

General Provider Information

NPI Number	:	1780378869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA NINEL CORTEZ PARKER COTA

Provider Business Mailing Address
First Line	:	7603 VAUGHAN CHAPEL RD
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-8096
Country	:	US
Telephone Number	:	252-296-6914
Fax Number	:

Provider Business Practice Location Address
First Line	:	7603 VAUGHAN CHAPEL RD
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-8096
Country	:	US
Telephone Number	:	252-296-6914
Fax Number	:

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

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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