MEDICARE: NICHOLAS PAUL SHORTY 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	3499	CA

General Provider Information

NPI Number	:	1427903368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS PAUL SHORTY COTA

Provider Business Mailing Address
First Line	:	17131 ROSCOE BLVD UNIT 12
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-5218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11441 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3143
Country	:	US
Telephone Number	:	818-980-8200
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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