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NPI Code Detail

MEDICARE: MS. AMANDA LYNNETTE MITCHELL COTA

MEDICARE: MS. AMANDA LYNNETTE MITCHELL 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
1224Z00000XOccupational Therapy Assistant5202007761MI

General Provider Information

NPI Number : 1215566484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA LYNNETTE MITCHELL COTA
Provider Business Mailing Address
First Line : 13137 N CLIO RD
Second Line :
City : CLIO
State : MI
Zip : 48420-1028
Country : US
Telephone Number : 810-686-3601
Fax Number :
Provider Business Practice Location Address
First Line : 13137 N CLIO RD
Second Line :
City : CLIO
State : MI
Zip : 48420-1028
Country : US
Telephone Number : 810-686-3601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2020
Last Update Date : 04/08/2020

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