MEDICARE: LANI DANAE RODRIGUEZ 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	224ZF0002X	Feeding, Eating & Swallowing Occupational Therapy Assistant	215842	TX

General Provider Information

NPI Number	:	1710595756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANI DANAE RODRIGUEZ COTA

Provider Business Mailing Address
First Line	:	1203 ELIZABETH BLVD
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-2313
Country	:	US
Telephone Number	:	817-279-2521
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 VILLAGE CREEK RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76119-4158
Country	:	US
Telephone Number	:	817-451-8704
Fax Number	:

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

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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