MEDICARE: HANNAH YOUNG 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	OTP-OTA-LIC-10502	MT

General Provider Information

NPI Number	:	1285465260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH YOUNG COTA

Provider Business Mailing Address
First Line	:	2200 GREAT NORTHERN AVE APT E11
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2683 PALMER ST STE B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1757
Country	:	US
Telephone Number	:	406-214-3131
Fax Number	:

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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