MEDICARE: MR. JOSE JUAN ORTIZ 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	002850-1	NY

General Provider Information

NPI Number	:	1588890156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE JUAN ORTIZ COTA

Provider Business Mailing Address
First Line	:	3140 GODWIN TERRACE
Second Line	:	APT E
City	:	BRONX
State	:	NY
Zip	:	10463-5469
Country	:	US
Telephone Number	:	646-261-6160
Fax Number	:	347-427-0510

Provider Business Practice Location Address
First Line	:	3140 GODWIN TERRACE
Second Line	:	APT E
City	:	BRONX
State	:	NY
Zip	:	10463-5469
Country	:	US
Telephone Number	:	646-261-6160
Fax Number	:	347-427-0510

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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