MEDICARE: STACY SYLVAIN 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	16706	FL

General Provider Information

NPI Number	:	1649752494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY SYLVAIN COTA

Provider Business Mailing Address
First Line	:	1131 NE 175TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 NE 175TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1238
Country	:	US
Telephone Number	:	754-207-2603
Fax Number	:

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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