MEDICARE: PHILLIP ROE 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	206750	TX

General Provider Information

NPI Number	:	1598067860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP ROE COTA

Provider Business Mailing Address
First Line	:	569 MARDELL LN
Second Line	:
City	:	HOWE
State	:	TX
Zip	:	75459-4452
Country	:	US
Telephone Number	:	903-532-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	569 MARDELL LN
Second Line	:
City	:	HOWE
State	:	TX
Zip	:	75459-4452
Country	:	US
Telephone Number	:	903-532-3945
Fax Number	:

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

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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Directions to “ PHILLIP ROE COTA” Practice Location

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