MEDICARE: ALEXANDER ANTHONY ADEGBEMBO 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	217042	TX

General Provider Information

NPI Number	:	1194491035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER ANTHONY ADEGBEMBO COTA

Provider Business Mailing Address
First Line	:	7324 SKILLMAN ST APT 2323
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-8463
Country	:	US
Telephone Number	:	469-360-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 WOODLAND PARK DR APT 1742
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-7618
Country	:	US
Telephone Number	:	469-360-1777
Fax Number	:

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

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	10/04/2021

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Directions to “ ALEXANDER ANTHONY ADEGBEMBO COTA” Practice Location

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