MEDICARE: MRS. NANCY REBECCA SYLVIA COTA/L

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	057002996	IL
2	224Z00000X	Occupational Therapy Assistant	OTA169	TN

General Provider Information

NPI Number	:	1801052378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY REBECCA SYLVIA COTA/L

Provider Business Mailing Address
First Line	:	333 1ST ST N
Second Line	:	SUITE200
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6945
Country	:	US
Telephone Number	:	904-241-9231
Fax Number	:	888-794-5038

Provider Business Practice Location Address
First Line	:	900 KIWANIS DR
Second Line	:
City	:	FREEPORT
State	:	IL
Zip	:	61032-4580
Country	:	US
Telephone Number	:	815-235-6196
Fax Number	:

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

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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