MEDICARE: MS. MONICA MARTINEZ 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	207489	TX

General Provider Information

NPI Number	:	1942241179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONICA MARTINEZ COTA

Provider Business Mailing Address
First Line	:	1105 JUSTICE AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-5942
Country	:	US
Telephone Number	:	806-792-3219
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 JUSTICE AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-5942
Country	:	US
Telephone Number	:	806-792-3219
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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