MEDICARE: MS. MAUREEN A ZAGACKI 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	OP002665L	PA

General Provider Information

NPI Number	:	1356679575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN A ZAGACKI COTA

Provider Business Mailing Address
First Line	:	3694 STANTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1619
Country	:	US
Telephone Number	:	215-438-5894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 OAK LANE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3340
Country	:	US
Telephone Number	:	215-570-3818
Fax Number	:

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

Provider Enumeration Date	:	11/29/2009
Last Update Date	:	03/20/2021

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