MEDICARE: TONIA JEAN FARRISH 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	0131000516	VA

General Provider Information

NPI Number	:	1952637407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA JEAN FARRISH COTA

Provider Business Mailing Address
First Line	:	85 MARS DR
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-3571
Country	:	US
Telephone Number	:	276-229-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 MARS DR
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-3571
Country	:	US
Telephone Number	:	276-229-9404
Fax Number	:

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

Provider Enumeration Date	:	10/18/2009
Last Update Date	:	10/18/2009

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