MEDICARE: KRISTEN M RADKE 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	620	MT

General Provider Information

NPI Number	:	1134445711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN M RADKE COTA

Provider Business Mailing Address
First Line	:	715 9TH AVE SW
Second Line	:
City	:	SIDNEY
State	:	MT
Zip	:	59270-4806
Country	:	US
Telephone Number	:	406-488-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 WILSON ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5078
Country	:	US
Telephone Number	:	406-874-2687
Fax Number	:

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

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	04/08/2010

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