MEDICARE: NAOMI AYETIN JOHNSON 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	210771	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24636339	OTHER	TX	TEXAS DRIVERS LIC

General Provider Information

NPI Number	:	1447559661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI AYETIN JOHNSON COTA

Provider Business Mailing Address
First Line	:	1212 GRAND PLAZA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-4165
Country	:	US
Telephone Number	:	832-229-7018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 GRAND PLAZA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-4165
Country	:	US
Telephone Number	:	832-229-7018
Fax Number	:

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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