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NPI Code Detail

MEDICARE: ANDREA DEAN COTA/L

MEDICARE: ANDREA DEAN 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
1224Z00000XOccupational Therapy Assistant9461738-4202UT

General Provider Information

NPI Number : 1093191132
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA DEAN COTA/L
Provider Business Mailing Address
First Line : 25117 SW PARKWAY AVE
Second Line : STE D
City : WILSONVILLE
State : OR
Zip : 97070-9697
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1430 E 4500 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84117-4208
Country : US
Telephone Number : 801-272-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2015
Last Update Date : 07/30/2015

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