MEDICARE: MARY J'ANICE MCCOY 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	0001124	CO

General Provider Information

NPI Number	:	1083198485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J'ANICE MCCOY COTA/L

Provider Business Mailing Address
First Line	:	1345 MEARS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2147
Country	:	US
Telephone Number	:	719-799-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 MEARS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2147
Country	:	US
Telephone Number	:	719-799-3381
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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