MEDICARE: MRS. DENISE HENRIETTE O'DANIELS 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	32002338A	IN

General Provider Information

NPI Number	:	1730420928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE HENRIETTE O'DANIELS COTA

Provider Business Mailing Address
First Line	:	1801 PARK AVE
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590-1638
Country	:	US
Telephone Number	:	574-267-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 PARK AVE
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590-1638
Country	:	US
Telephone Number	:	574-267-8160
Fax Number	:

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

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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