MEDICARE: DANIELLE STOFFERS 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	212555	TX

General Provider Information

NPI Number	:	1548676398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE STOFFERS COTA

Provider Business Mailing Address
First Line	:	1905 ATLANTIC ST
Second Line	:	324
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-2463
Country	:	US
Telephone Number	:	321-514-0626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 ATLANTIC ST
Second Line	:	324
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-2463
Country	:	US
Telephone Number	:	321-514-0626
Fax Number	:

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	07/01/2014

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