MEDICARE: DANIELLE LYNN JOHNSON 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	32003230A	IN

General Provider Information

NPI Number	:	1578073615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LYNN JOHNSON COTA

Provider Business Mailing Address
First Line	:	2228 SILVER SPOON DR
Second Line	:
City	:	GREENFIELD
State	:	IN
Zip	:	46140
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	868 S WASHINGTON ST
Second Line	:
City	:	MORRISTOWN
State	:	IN
Zip	:	46161-9633
Country	:	US
Telephone Number	:	765-763-6012
Fax Number	:

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

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	04/15/2023

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