MEDICARE: CODY VUKOVICH 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

General Provider Information

NPI Number	:	1578345955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY VUKOVICH COTA

Provider Business Mailing Address
First Line	:	1461 OGALLALA ST UNIT 2
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-7286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 E CALVADA BLVD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-2797
Country	:	US
Telephone Number	:	702-339-8770
Fax Number	:

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

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	10/19/2023

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Directions to “ CODY VUKOVICH COTA” Practice Location

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