MEDICARE: KIMBERLY HAMMOND 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	002340-1	NY

General Provider Information

NPI Number	:	1134432354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HAMMOND COTA

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-0367
Country	:	US
Telephone Number	:	518-235-2329
Fax Number	:	518-235-9791

Provider Business Practice Location Address
First Line	:	81 MOHAWK ST
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-2809
Country	:	US
Telephone Number	:	518-235-2329
Fax Number	:	518-235-9791

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	07/16/2010

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