MEDICARE: MR. WINDEL B STEWART 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	5954797UPD	NY

General Provider Information

NPI Number	:	1609993716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WINDEL B STEWART COTA

Provider Business Mailing Address
First Line	:	3605 MICKLE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1614
Country	:	US
Telephone Number	:	845-729-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 STILLWELL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-0000
Country	:	US
Telephone Number	:	718-652-9790
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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