MEDICARE: DINA DAVOLIO 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	OTA2966

General Provider Information

NPI Number	:	1811532757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA DAVOLIO COTA

Provider Business Mailing Address
First Line	:	33262 SEA KNOLL DR
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-1137
Country	:	US
Telephone Number	:	949-412-3753
Fax Number	:

Provider Business Practice Location Address
First Line	:	24422 AVENIDA DE LA CARLOTA STE 100
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3648
Country	:	US
Telephone Number	:	949-916-1654
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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