MEDICARE: MR. MICHAEL EDWARD SORRENTINO II 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	OTA10558	FL

General Provider Information

NPI Number	:	1235400870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EDWARD SORRENTINO II COTA

Provider Business Mailing Address
First Line	:	4325 WILLOWCREST CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-2629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 WILLOWCREST CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-2629
Country	:	US
Telephone Number	:	407-971-3977
Fax Number	:

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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