MEDICARE: AMY M ZAMUDIO 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	225XP0200X	Pediatric Occupational Therapist	8351450-4202	UT

General Provider Information

NPI Number	:	1629841903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M ZAMUDIO COTA/L

Provider Business Mailing Address
First Line	:	6895 S 2510 E
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3303
Country	:	US
Telephone Number	:	801-879-3907
Fax Number	:

Provider Business Practice Location Address
First Line	:	6895 S 2510 E
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3303
Country	:	US
Telephone Number	:	801-879-3907
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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