MEDICARE: MRS. SHAKIRAT OLABISI AROWOROWON 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	A02138	MD

General Provider Information

NPI Number	:	1205467768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAKIRAT OLABISI AROWOROWON COTA

Provider Business Mailing Address
First Line	:	5310 OLD COURT RD
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-5243
Country	:	US
Telephone Number	:	443-857-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 WOODBRIDGE STATION WAY STE 102
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-3852
Country	:	US
Telephone Number	:	443-857-7985
Fax Number	:

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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