MEDICARE: BRITTNEY WARREN 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	2300	CA

General Provider Information

NPI Number	:	1356878078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTNEY WARREN COTA

Provider Business Mailing Address
First Line	:	29402 TOURNAMENT
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4735
Country	:	US
Telephone Number	:	909-446-5836
Fax Number	:

Provider Business Practice Location Address
First Line	:	29402 TOURNAMENT
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4735
Country	:	US
Telephone Number	:	909-446-5836
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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