MEDICARE: MISS MISTY ALTONAGA 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	0131001549	VA

General Provider Information

NPI Number	:	1114373925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MISTY ALTONAGA COTA

Provider Business Mailing Address
First Line	:	4650 SOUTH BLVD STE 310
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1003
Country	:	US
Telephone Number	:	757-490-3223
Fax Number	:	757-490-2936

Provider Business Practice Location Address
First Line	:	4650 SOUTH BLVD STE 310
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1003
Country	:	US
Telephone Number	:	757-490-3223
Fax Number	:	757-490-2936

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

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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