MEDICARE: MRS. DENISE MARIE HILLIS 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	2005018055	MO

General Provider Information

NPI Number	:	1659569242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE MARIE HILLIS COTA

Provider Business Mailing Address
First Line	:	105 SPRUCE ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1002
Country	:	US
Telephone Number	:	573-783-3993
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SPRUCE ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1002
Country	:	US
Telephone Number	:	573-783-3993
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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