MEDICARE: MELINDA WILT COTA/L

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	1937	SC

General Provider Information

NPI Number	:	1184719494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA WILT COTA/L

Provider Business Mailing Address
First Line	:	27 HARMONY CIR
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1661
Country	:	US
Telephone Number	:	864-862-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 GULLIVER ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-2105
Country	:	US
Telephone Number	:	864-862-2554
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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