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NPI Code Detail

MEDICARE: MICHAEL T LUTZ COTA

MEDICARE: MICHAEL T LUTZ 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 Assistant5243AZ

General Provider Information

NPI Number : 1972856623
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL T LUTZ COTA
Provider Business Mailing Address
First Line : 1570 PASEO GRANDE
Second Line : APT 2011
City : BULLHEAD CITY
State : AZ
Zip : 86442-8523
Country : US
Telephone Number : 715-292-8785
Fax Number :
Provider Business Practice Location Address
First Line : 2150 SILVER CREEK RD
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-8472
Country : US
Telephone Number : 928-763-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2012
Last Update Date : 10/18/2012

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