MEDICARE: DANI SIMON 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	15036	FL
2	172V00000X	Community Health Worker	15036	FL
3	251E00000X	Home Health Agency	15036	FL

General Provider Information

NPI Number	:	1861934408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANI SIMON COTA/L

Provider Business Mailing Address
First Line	:	2385 FOUNTAIN RD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-4073
Country	:	US
Telephone Number	:	407-489-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	2385 FOUNTAIN RD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-4073
Country	:	US
Telephone Number	:	407-489-9044
Fax Number	:

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

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/15/2016

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