MEDICARE: MRS. ANDRIA KRISITIN SPRUIELL 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	210024	TX

General Provider Information

NPI Number	:	1821283839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDRIA KRISITIN SPRUIELL COTA

Provider Business Mailing Address
First Line	:	1252 MOUNTAIN AIR TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5445
Country	:	US
Telephone Number	:	817-880-4972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 MOUNTAIN AIR TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5445
Country	:	US
Telephone Number	:	817-880-4972
Fax Number	:

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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