MEDICARE: ADRIA RENE CORY COTA/L

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	5922	AZ

General Provider Information

NPI Number	:	1013423151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIA RENE CORY COTA/L

Provider Business Mailing Address
First Line	:	6217 W WARNER ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1917
Country	:	US
Telephone Number	:	602-820-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	6217 W WARNER ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1917
Country	:	US
Telephone Number	:	602-820-3668
Fax Number	:

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

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/27/2017

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