MEDICARE: MRS. LISA SANTIAGO 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	OTA 15199	FL

General Provider Information

NPI Number	:	1003268418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA SANTIAGO COTA

Provider Business Mailing Address
First Line	:	2179 SW OAKWATER PT
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-7721
Country	:	US
Telephone Number	:	772-284-7926
Fax Number	:

Provider Business Practice Location Address
First Line	:	2179 SW OAKWATER PT
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-7721
Country	:	US
Telephone Number	:	772-284-7926
Fax Number	:

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

Provider Enumeration Date	:	07/09/2016
Last Update Date	:	07/09/2016

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