MEDICARE: MRS. ELSIE CASTRO 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	11218	FL

General Provider Information

NPI Number	:	1275832651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELSIE CASTRO COTA

Provider Business Mailing Address
First Line	:	6530 LAKE PATRICIA DR APT E28
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-3089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16969 NW 67TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4214
Country	:	US
Telephone Number	:	305-364-4331
Fax Number	:

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

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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