MEDICARE: MR. JOSEPH E. GRAY 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	209843	TX

General Provider Information

NPI Number	:	1750519344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH E. GRAY COTA

Provider Business Mailing Address
First Line	:	2047 SHADOW ROCK DR.
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2233
Country	:	US
Telephone Number	:	832-202-8308
Fax Number	:	281-358-5890

Provider Business Practice Location Address
First Line	:	2047 SHADOW ROCK DRIVE
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2233
Country	:	US
Telephone Number	:	832-202-8308
Fax Number	:	281-358-5890

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	06/23/2009

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