MEDICARE: SEAN MICHAEL HARDIN 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	2009014427	MO

General Provider Information

NPI Number	:	1649592437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MICHAEL HARDIN COTA

Provider Business Mailing Address
First Line	:	3321 CARRIAGE XING
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-3222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 CARRIAGE XING
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-3222
Country	:	US
Telephone Number	:	636-916-5240
Fax Number	:

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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