MEDICARE: MS. IRIS E HASSAN 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	32001401A	IN

General Provider Information

NPI Number	:	1922202662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS E HASSAN COTA

Provider Business Mailing Address
First Line	:	4325 ALDER ST
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3155
Country	:	US
Telephone Number	:	219-397-1080
Fax Number	:	219-397-1080

Provider Business Practice Location Address
First Line	:	4325 ALDER ST
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3155
Country	:	US
Telephone Number	:	219-397-1080
Fax Number	:	219-397-1080

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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