MEDICARE: MRS. SANDRA ROSE NUNN 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		CO

General Provider Information

NPI Number	:	1932404829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA ROSE NUNN COTA

Provider Business Mailing Address
First Line	:	427 STEVENS CIR
Second Line	:
City	:	PLATTEVILLE
State	:	CO
Zip	:	80651-7900
Country	:	US
Telephone Number	:	970-785-6114
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 STEVENS CIR
Second Line	:
City	:	PLATTEVILLE
State	:	CO
Zip	:	80651-7900
Country	:	US
Telephone Number	:	970-785-6114
Fax Number	:

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

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	01/24/2011

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