MEDICARE: MS. REBECCA J AMOS 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	32001465A	IN

General Provider Information

NPI Number	:	1154585263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA J AMOS COTA

Provider Business Mailing Address
First Line	:	1832 GRAFTON PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-3526
Country	:	US
Telephone Number	:	260-459-2408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1832 GRAFTON PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-3526
Country	:	US
Telephone Number	:	260-459-2408
Fax Number	:

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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