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NPI Code Detail

MEDICARE: MRS. SUSAN M STATON COTA

MEDICARE: MRS. SUSAN M STATON 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
1224Z00000XOccupational Therapy Assistant2701NM

General Provider Information

NPI Number : 1336460062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN M STATON COTA
Provider Business Mailing Address
First Line : 220 VALLE VIS
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-3231
Country : US
Telephone Number : 505-327-3882
Fax Number :
Provider Business Practice Location Address
First Line : 800 SAGUARO TRL
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-9632
Country : US
Telephone Number : 505-598-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2010
Last Update Date : 06/16/2010

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