MEDICARE: MS. DANA KRISTEN PERALTA COTA/L

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	5295

General Provider Information

NPI Number	:	1508101262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA KRISTEN PERALTA COTA/L

Provider Business Mailing Address
First Line	:	3385 E CLAXTON AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-9395
Country	:	US
Telephone Number	:	480-518-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E WARNER RD
Second Line	:	SUITE 106
City	:	CHANDLER
State	:	AZ
Zip	:	85225-1057
Country	:	US
Telephone Number	:	480-963-5800
Fax Number	:

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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