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NPI Code Detail

MEDICARE: MISS CHARMAINE LUMBAO COTA

MEDICARE: MISS CHARMAINE LUMBAO 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
1224Z00000XOccupational Therapy Assistant

General Provider Information

NPI Number : 1972030591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CHARMAINE LUMBAO COTA
Provider Business Mailing Address
First Line : 4560 SE INTERNATIONAL WAY STE 100
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-4628
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2800 S 224TH ST
Second Line :
City : DES MOINES
State : WA
Zip : 98198-5132
Country : US
Telephone Number : 206-824-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2017
Last Update Date : 05/13/2017

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Directions to “ MISS CHARMAINE LUMBAO COTA” Practice Location

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