MEDICARE: MRS. LISA CASSIERE 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	OTA492	FL

General Provider Information

NPI Number	:	1932449725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA CASSIERE COTA/L

Provider Business Mailing Address
First Line	:	2552 GLENRIDGE CIR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-2933
Country	:	US
Telephone Number	:	321-453-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2552 GLENRIDGE CIR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-2933
Country	:	US
Telephone Number	:	321-453-6128
Fax Number	:

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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