MEDICARE: MARY JANE WILLIAMS 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	32002545A	IN

General Provider Information

NPI Number	:	1891123873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE WILLIAMS COTA

Provider Business Mailing Address
First Line	:	6239 S EAST ST
Second Line	:	STE. A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2090
Country	:	US
Telephone Number	:	317-791-9031
Fax Number	:	317-791-9001

Provider Business Practice Location Address
First Line	:	6239 S EAST ST
Second Line	:	STE. A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2090
Country	:	US
Telephone Number	:	317-791-9031
Fax Number	:	317-791-9001

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

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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