MEDICARE: JESSICA RENEE DECHERT 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	7446	AZ

General Provider Information

NPI Number	:	1679038418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENEE DECHERT COTA

Provider Business Mailing Address
First Line	:	4212 E 4TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1956
Country	:	US
Telephone Number	:	520-720-8115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5830 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-5611
Country	:	US
Telephone Number	:	520-722-5515
Fax Number	:

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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