MEDICARE: BUKOLA CHARLES AYANDARE 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

General Provider Information

NPI Number	:	1740995653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUKOLA CHARLES AYANDARE COTA

Provider Business Mailing Address
First Line	:	1180 MADISON CHASE APT 6
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-3297
Country	:	US
Telephone Number	:	561-223-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 MADISON CHASE APT 6
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-3297
Country	:	US
Telephone Number	:	561-223-6593
Fax Number	:

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

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	01/16/2023

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