MEDICARE: DENISE ANDERSON C.O.T.A.

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	OTA11870	FL

General Provider Information

NPI Number	:	1356719066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE ANDERSON C.O.T.A.

Provider Business Mailing Address
First Line	:	2402 MELISSA ANN CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-3595
Country	:	US
Telephone Number	:	757-575-8925
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 MELISSA ANN CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-3595
Country	:	US
Telephone Number	:	757-575-8925
Fax Number	:

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

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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