MEDICARE: MR. KENNETH MURRAY JR. 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	3381	TN

General Provider Information

NPI Number	:	1881297711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH MURRAY JR. COTA

Provider Business Mailing Address
First Line	:	2904 COPPER RIDGE CV N
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-8542
Country	:	US
Telephone Number	:	901-413-1247
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 COPPER RIDGE CV N
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-8542
Country	:	US
Telephone Number	:	901-413-1247
Fax Number	:

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

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	07/08/2024

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