MEDICARE: NICOLE CURTIS 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	0131000708	VA

General Provider Information

NPI Number	:	1093038820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CURTIS COTA/L

Provider Business Mailing Address
First Line	:	1900 LINDALE ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-2841
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 LINDALE ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-2841
Country	:	US
Telephone Number	:	757-639-3424
Fax Number	:

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

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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