MEDICARE: MRS. KELLIE DENISE MITCHELL 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	1726	AZ

General Provider Information

NPI Number	:	1942448287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLIE DENISE MITCHELL COTA/L

Provider Business Mailing Address
First Line	:	16900 W CALLE CARMELA
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-9215
Country	:	US
Telephone Number	:	520-682-6153
Fax Number	:

Provider Business Practice Location Address
First Line	:	16900 W CALLE CARMELA
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-9215
Country	:	US
Telephone Number	:	520-682-6153
Fax Number	:

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

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	01/23/2009

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