MEDICARE: MS. VALERIE R. BELT 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	4780-27	WI

General Provider Information

NPI Number	:	1205143864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE R. BELT COTA

Provider Business Mailing Address
First Line	:	1401 CHURCHILL STREET
Second Line	:	CRYSTAL RIVER NURSING
City	:	WAUPACA
State	:	WI
Zip	:	54981
Country	:	US
Telephone Number	:	715-258-8131
Fax Number	:	715-258-0179

Provider Business Practice Location Address
First Line	:	1401 CHURCHILL ST.
Second Line	:	CRYSTAL RIVER NURSING
City	:	WAUPACA
State	:	WI
Zip	:	54981
Country	:	US
Telephone Number	:	715-258-8131
Fax Number	:	715-258-0179

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	10/15/2012

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