MEDICARE: MELISSA STARK 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	OTA001085	GA

General Provider Information

NPI Number	:	1386891513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA STARK COTA

Provider Business Mailing Address
First Line	:	1941 WINDSOR SPRING RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-5821
Country	:	US
Telephone Number	:	706-495-5439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 WINDSOR SPRING RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-5821
Country	:	US
Telephone Number	:	706-495-5439
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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