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NPI Code Detail

MEDICARE: LORI COATE COTA

MEDICARE: LORI COATE 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-1214ID

General Provider Information

NPI Number : 1386002202
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI COATE COTA
Provider Business Mailing Address
First Line : 449 S FITNESS PL
Second Line :
City : EAGLE
State : ID
Zip : 83616-6828
Country : US
Telephone Number : 208-957-6301
Fax Number : 208-228-0585
Provider Business Practice Location Address
First Line : 449 S FITNESS PL
Second Line :
City : EAGLE
State : ID
Zip : 83616-6828
Country : US
Telephone Number : 208-957-6301
Fax Number : 208-228-0585
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2016
Last Update Date : 02/05/2016

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Directions to “ LORI COATE COTA” Practice Location

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