MEDICARE: YAN JIN COTA/L

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	010004-01	NY

General Provider Information

NPI Number	:	1326750183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAN JIN COTA/L

Provider Business Mailing Address
First Line	:	8320 13TH AVE # 356
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-5018
Country	:	US
Telephone Number	:	347-403-3063
Fax Number	:

Provider Business Practice Location Address
First Line	:	3929 NEW UTRECHT AVE APT 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1868
Country	:	US
Telephone Number	:	347-403-3063
Fax Number	:

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

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	12/22/2022

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