MEDICARE: MISS PATRICIA KEPLINGER 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	32001394A	IN

General Provider Information

NPI Number	:	1033448980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PATRICIA KEPLINGER COTA

Provider Business Mailing Address
First Line	:	5405 MONARCH DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7455
Country	:	US
Telephone Number	:	260-493-6143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 NORTH CLINTON STREET
Second Line	:	5405 MONARCH DR.
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-7455
Country	:	US
Telephone Number	:	260-484-0602
Fax Number	:

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

Provider Enumeration Date	:	12/23/2009
Last Update Date	:	12/23/2009

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