MEDICARE: RODELEINE M. SALVATUS BUSTAMANTE 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	387105	AZ

General Provider Information

NPI Number	:	1598288763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODELEINE M. SALVATUS BUSTAMANTE COTA

Provider Business Mailing Address
First Line	:	4411 E CHANDLER BLVD APT 1015
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7658
Country	:	US
Telephone Number	:	520-229-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 S GILBERT RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6000
Country	:	US
Telephone Number	:	623-850-8420
Fax Number	:	844-273-5997

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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