MEDICARE: ANDREA PEREZ COTA/L

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	OTA 10583	FL

General Provider Information

NPI Number	:	1629319728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA PEREZ COTA/L

Provider Business Mailing Address
First Line	:	13506 SUMMERPORT VILLAGE PKWY
Second Line	:	SUITE: 410
City	:	WINDERMERE
State	:	FL
Zip	:	34786-7366
Country	:	US
Telephone Number	:	407-905-9300
Fax Number	:	407-905-9309

Provider Business Practice Location Address
First Line	:	7380 W SAND LAKE RD
Second Line	:	SUITE 500
City	:	ORLANDO
State	:	FL
Zip	:	32819-5248
Country	:	US
Telephone Number	:	407-905-9300
Fax Number	:	407-905-9309

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

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	12/04/2014

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