MEDICARE: MRS. REBECCA ANN WADE 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	OA565	OK

General Provider Information

NPI Number	:	1346459914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA ANN WADE COTA

Provider Business Mailing Address
First Line	:	5617 NW 103RD PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6987
Country	:	US
Telephone Number	:	405-550-2092
Fax Number	:	405-721-2452

Provider Business Practice Location Address
First Line	:	2815 E JACKSON ST
Second Line	:
City	:	HUGO
State	:	OK
Zip	:	74743-4250
Country	:	US
Telephone Number	:	580-326-9200
Fax Number	:	580-326-8876

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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