MEDICARE: MS. KATHLEEN MARIE OHM 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	OTA433	FL

General Provider Information

NPI Number	:	1740314426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN MARIE OHM COTA

Provider Business Mailing Address
First Line	:	2600 KAREN DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9425
Country	:	US
Telephone Number	:	352-383-4534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 KAREN DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9425
Country	:	US
Telephone Number	:	352-383-4534
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/12/2009

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