MEDICARE: CONSUELA T. JENKINS 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	2435	SC

General Provider Information

NPI Number	:	1366787657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSUELA T. JENKINS COTA

Provider Business Mailing Address
First Line	:	PO BOX 2982
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-2982
Country	:	US
Telephone Number	:	803-455-7373
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3103
Country	:	US
Telephone Number	:	803-455-7373
Fax Number	:

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

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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