MEDICARE: MR. MICHAEL DUFFY ROSE 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	336222	LA

General Provider Information

NPI Number	:	1295417954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DUFFY ROSE COTA

Provider Business Mailing Address
First Line	:	234B HIDDEN HILLS RD
Second Line	:
City	:	ARNAUDVILLE
State	:	LA
Zip	:	70512-6430
Country	:	US
Telephone Number	:	337-849-2501
Fax Number	:

Provider Business Practice Location Address
First Line	:	234B HIDDEN HILLS RD
Second Line	:
City	:	ARNAUDVILLE
State	:	LA
Zip	:	70512-6430
Country	:	US
Telephone Number	:	337-849-2501
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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