MEDICARE: CHARLIE CASIMIR 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	OTA1108	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346700408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE CASIMIR COTA/L

Provider Business Mailing Address
First Line	:	2600 COMPASS RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 WILLA SPRINGS DR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5214
Country	:	US
Telephone Number	:	407-699-5506
Fax Number	:

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

Provider Enumeration Date	:	03/23/2019
Last Update Date	:	03/23/2019

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Directions to “ CHARLIE CASIMIR COTA/L” Practice Location

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