MEDICARE: MS. KIM ANN MAHONEY 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	007772	NY

General Provider Information

NPI Number	:	1558634006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM ANN MAHONEY COTA

Provider Business Mailing Address
First Line	:	1210 PURITAN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-6153
Country	:	US
Telephone Number	:	718-892-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 PURITAN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-6153
Country	:	US
Telephone Number	:	718-892-8995
Fax Number	:

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

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	02/14/2012

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