MEDICARE: NICOLE MICHELLE CANNELLA 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	19601	FL

General Provider Information

NPI Number	:	1023791803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MICHELLE CANNELLA COTA/L

Provider Business Mailing Address
First Line	:	108 NE 16TH AVE APT 406
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3842
Country	:	US
Telephone Number	:	954-459-5106
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 NE 16TH AVE APT 406
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3842
Country	:	US
Telephone Number	:	954-459-5106
Fax Number	:

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

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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