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NPI Code Detail

MEDICARE: CHYNA AVERY COTA

MEDICARE: CHYNA AVERY 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
1224Z00000XOccupational Therapy Assistant216590TX

General Provider Information

NPI Number : 1780340059
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHYNA AVERY COTA
Provider Business Mailing Address
First Line : 8477 S SUNCOAST BLVD
Second Line :
City : HOMOSASSA
State : FL
Zip : 34446-5028
Country : US
Telephone Number : 800-804-9961
Fax Number : 352-382-1146
Provider Business Practice Location Address
First Line : 5100 RANDOL MILL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-1553
Country : US
Telephone Number : 817-451-8001
Fax Number : 352-382-1146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2021
Last Update Date : 11/11/2021

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