MEDICARE: STEPHANIE LEE 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	3382	SC

General Provider Information

NPI Number	:	1528456142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LEE COTA

Provider Business Mailing Address
First Line	:	1100 DAVID ST APT 4408
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-7605
Country	:	US
Telephone Number	:	864-650-3947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 DAVID ST APT 4408
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-7605
Country	:	US
Telephone Number	:	864-650-3947
Fax Number	:

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

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