MEDICARE: MS. SUSAN KAY OLANDER 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	836	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427348622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN KAY OLANDER COTA

Provider Business Mailing Address
First Line	:	8777 TULARE DR UNIT 408A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-6288
Country	:	US
Telephone Number	:	714-274-9381
Fax Number	:

Provider Business Practice Location Address
First Line	:	8777 TULARE DR UNIT 408A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-6288
Country	:	US
Telephone Number	:	714-274-9381
Fax Number	:

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

Provider Enumeration Date	:	04/09/2011
Last Update Date	:	04/09/2011

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