MEDICARE: MRS. KRISTINA M. BRICKEY 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	2452	CA

General Provider Information

NPI Number	:	1083167696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA M. BRICKEY COTA/L

Provider Business Mailing Address
First Line	:	324 N PARKER ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2231
Country	:	US
Telephone Number	:	714-470-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	24422 AVENIDA DE LA CARLOTA STE 100
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3648
Country	:	US
Telephone Number	:	949-916-1654
Fax Number	:

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

Provider Enumeration Date	:	07/31/2016
Last Update Date	:	07/31/2016

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