MEDICARE: MEGAL PATTERSON JR. 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	009179-1	NY

General Provider Information

NPI Number	:	1093251522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAL PATTERSON JR. COTA

Provider Business Mailing Address
First Line	:	388 LAKESIDE AVE
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-2816
Country	:	US
Telephone Number	:	321-946-5697
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 LAKESIDE AVE
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-2816
Country	:	US
Telephone Number	:	321-946-5697
Fax Number	:

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

Provider Enumeration Date	:	01/08/2017
Last Update Date	:	01/08/2017

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