MEDICARE: MR. REGINALD JEROME JONES 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

General Provider Information

NPI Number	:	1942285457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REGINALD JEROME JONES COTA

Provider Business Mailing Address
First Line	:	CMR 442 BOX 83
Second Line	:
City	:	APO
State	:	AE
Zip	:	09042
Country	:	DE
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4993 TRAFALGAR ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44706-2163
Country	:	US
Telephone Number	:	330-478-2818
Fax Number	:

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/08/2007

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