MEDICARE: RENEE GALVAN 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	2004002716	MO

General Provider Information

NPI Number	:	1952511263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE GALVAN COTA

Provider Business Mailing Address
First Line	:	2303 HOLLY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2250
Country	:	US
Telephone Number	:	816-842-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 HOLLY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2250
Country	:	US
Telephone Number	:	816-842-8862
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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