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NPI Code Detail

MEDICARE: MR. RICHARD L. BREWER COTA

MEDICARE: MR. RICHARD L. BREWER 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-00941OH

General Provider Information

NPI Number : 1396065124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD L. BREWER COTA
Provider Business Mailing Address
First Line : 960 WASHINGTON AVE
Second Line :
City : GREENVILLE
State : OH
Zip : 45331-1133
Country : US
Telephone Number : 937-548-4461
Fax Number :
Provider Business Practice Location Address
First Line : 5040 PHILADELPHIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45415-3604
Country : US
Telephone Number : 937-278-0404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2010
Last Update Date : 03/01/2011

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