MEDICARE: MS. TONYA NICHOLE BROWN 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	225X00000X	Occupational Therapist	3720	NM

General Provider Information

NPI Number	:	1629594122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONYA NICHOLE BROWN COTA/L

Provider Business Mailing Address
First Line	:	915 LOS PADRES PL SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-5946
Country	:	US
Telephone Number	:	505-814-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 LOS PADRES PL SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-5946
Country	:	US
Telephone Number	:	505-814-4625
Fax Number	:

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

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	10/01/2025

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