MEDICARE: MRS. DIANNE BROWN IV 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	OTA8818	FL

General Provider Information

NPI Number	:	1598941213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE BROWN IV COTA

Provider Business Mailing Address
First Line	:	590 ROYAL POINCIANA CT
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-1712
Country	:	US
Telephone Number	:	954-384-6032
Fax Number	:	954-384-1213

Provider Business Practice Location Address
First Line	:	590 ROYAL POINCIANA CT
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-1712
Country	:	US
Telephone Number	:	954-384-6032
Fax Number	:	954-384-1213

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/09/2012

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