MEDICARE: MS. LAKESHA ANN CARTER 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	OTA#8929	FL

General Provider Information

NPI Number	:	1801199096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAKESHA ANN CARTER COTA

Provider Business Mailing Address
First Line	:	125 NW 109TH AVE
Second Line	:	APT #301
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-5114
Country	:	US
Telephone Number	:	954-435-5040
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 NE 141ST ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-2837
Country	:	US
Telephone Number	:	305-893-1102
Fax Number	:

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

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	12/10/2010

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