MEDICARE: KRISTI ELLEFSEN 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	4738858-4202	UT
2	224Z00000X	Occupational Therapy Assistant	OC 60038172	WA

General Provider Information

NPI Number	:	1457502965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI ELLEFSEN COTA

Provider Business Mailing Address
First Line	:	6807 PINE ROCK CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3405
Country	:	US
Telephone Number	:	801-259-0732
Fax Number	:

Provider Business Practice Location Address
First Line	:	6807 PINE ROCK CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3405
Country	:	US
Telephone Number	:	801-259-0732
Fax Number	:

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/02/2008

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