MEDICARE: VALARIE ODLE 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	14298	NC
2	224Z00000X	Occupational Therapy Assistant	5500	SC

General Provider Information

NPI Number	:	1689450793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALARIE ODLE COTA

Provider Business Mailing Address
First Line	:	9538 OSWALD LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 LENGERS WAY
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-4200
Country	:	US
Telephone Number	:	803-877-6408
Fax Number	:

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

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/08/2023

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Directions to “ VALARIE ODLE COTA” Practice Location

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