MEDICARE: ELIZABETH LEONARD COTA/L

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	003647-1	NY

General Provider Information

NPI Number	:	1396395596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LEONARD COTA/L

Provider Business Mailing Address
First Line	:	6733 211TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2505
Country	:	US
Telephone Number	:	347-886-5872
Fax Number	:

Provider Business Practice Location Address
First Line	:	6733 211TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2505
Country	:	US
Telephone Number	:	347-886-5872
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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