MEDICARE: TRENTON ANDREW HALCOMB 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	32001996A	IN

General Provider Information

NPI Number	:	1659623106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENTON ANDREW HALCOMB COTA

Provider Business Mailing Address
First Line	:	3419 CHESWICK CT APT 1
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-7451
Country	:	US
Telephone Number	:	219-895-1297
Fax Number	:

Provider Business Practice Location Address
First Line	:	3419 CHESWICK CT APT 1
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-7451
Country	:	US
Telephone Number	:	219-895-1297
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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