MEDICARE: KRISTIN PAGE KASS 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	212930	TX

General Provider Information

NPI Number	:	1386124808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN PAGE KASS COTA

Provider Business Mailing Address
First Line	:	200 N FESTIVAL DR APT 1203
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6228
Country	:	US
Telephone Number	:	915-443-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N FESTIVAL DR APT 1203
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6228
Country	:	US
Telephone Number	:	915-443-1947
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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