MEDICARE: KEYLON GEORGE 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	A02959	MD

General Provider Information

NPI Number	:	1881365211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYLON GEORGE COTA

Provider Business Mailing Address
First Line	:	2437 COPPER MOUNTAIN TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-6229
Country	:	US
Telephone Number	:	803-357-2142
Fax Number	:

Provider Business Practice Location Address
First Line	:	2437 COPPER MOUNTAIN TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-6229
Country	:	US
Telephone Number	:	803-357-2142
Fax Number	:

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

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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