MEDICARE: STEPHANIE CHRISTINE MILLER 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	005526-1	NY
2	224Z00000X	Occupational Therapy Assistant	OP006797	PA

General Provider Information

NPI Number	:	1639408966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CHRISTINE MILLER COTA

Provider Business Mailing Address
First Line	:	299 BALLOU RD
Second Line	:
City	:	PORTER CORNERS
State	:	NY
Zip	:	12859-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 TOWER RD
Second Line	:
City	:	BRISTOL
State	:	PA
Zip	:	19007-3116
Country	:	US
Telephone Number	:	215-285-2239
Fax Number	:

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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