MEDICARE: MS. PAULETTE ANN RICHARDS COTA L BCIAC BA

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	225400000X	Rehabilitation Practitioner	247221	OR
2	225400000X	Rehabilitation Practitioner	B4538	CO

General Provider Information

NPI Number	:	1518923200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULETTE ANN RICHARDS COTA L BCIAC BA

Provider Business Mailing Address
First Line	:	24820 PARADISE DRIVE
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448
Country	:	US
Telephone Number	:	541-935-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	24820 PARADISE DRIVE
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448
Country	:	US
Telephone Number	:	541-935-7658
Fax Number	:

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

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	07/08/2007

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