MEDICARE: CHRISTOPHER SMITH 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	215560	TX

General Provider Information

NPI Number	:	1104383835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER SMITH COTA

Provider Business Mailing Address
First Line	:	1714 FM 2496 W
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-5035
Country	:	US
Telephone Number	:	903-806-8680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 FM 2496 W
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-5035
Country	:	US
Telephone Number	:	903-806-8680
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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