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NPI Code Detail

MEDICARE: AUBREY CORLETTE MENTIS JR. COTA

MEDICARE: AUBREY CORLETTE MENTIS JR. 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
1224Z00000XOccupational Therapy Assistant1801136KS

General Provider Information

NPI Number : 1629460241
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUBREY CORLETTE MENTIS JR. COTA
Provider Business Mailing Address
First Line : 228 S FORESTVIEW CT
Second Line : NONE
City : WICHITA
State : KS
Zip : 67235-8225
Country : US
Telephone Number : 316-305-5073
Fax Number :
Provider Business Practice Location Address
First Line : 1601 ACADEMY RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-4409
Country : US
Telephone Number : 580-749-5923
Fax Number : 580-749-5924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2015
Last Update Date : 02/19/2015

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