MEDICARE: BRANDON ROWE 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	174400000X	Specialist	OC00001017	WA

General Provider Information

NPI Number	:	1609044908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON ROWE COTA

Provider Business Mailing Address
First Line	:	10011 BRIDGEPT WAY SW
Second Line	:	SUITE 1500
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PMB 294 10011 BRIDGEPT WAY SW
Second Line	:	SUITE 1500
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2332
Country	:	US
Telephone Number	:	253-720-9157
Fax Number	:

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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Directions to “ BRANDON ROWE COTA” Practice Location

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