MEDICARE: MISS MARILEE LINDA NELSON 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	11007	FL

General Provider Information

NPI Number	:	1477854842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARILEE LINDA NELSON COTA

Provider Business Mailing Address
First Line	:	5131 RICHMOND TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2327
Country	:	US
Telephone Number	:	941-916-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	5131 RICHMOND TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2327
Country	:	US
Telephone Number	:	941-916-4430
Fax Number	:

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

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	11/16/2010

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