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NPI Code Detail

MEDICARE: PAMELA GAYLE BRODEUR COTA

MEDICARE: PAMELA GAYLE BRODEUR 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
1224Z00000XOccupational Therapy AssistantOTA 8752FL

General Provider Information

NPI Number : 1376669705
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA GAYLE BRODEUR COTA
Provider Business Mailing Address
First Line : 7 ZEOLITE PL
Second Line :
City : PALM COAST
State : FL
Zip : 32164-5229
Country : US
Telephone Number : 386-206-4834
Fax Number :
Provider Business Practice Location Address
First Line : 350 S RIDGEWOOD AVE
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-7028
Country : US
Telephone Number : 386-677-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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