MEDICARE: JUDITH DIAZ 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	174400000X	Specialist	OTA12521	FL
2	224Z00000X	Occupational Therapy Assistant	12521	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTA12521	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1962837716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH DIAZ COTA

Provider Business Mailing Address
First Line	:	7261 S WATERWAY DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-2766
Country	:	US
Telephone Number	:	786-406-9552
Fax Number	:

Provider Business Practice Location Address
First Line	:	7261 S WATERWAY DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-2766
Country	:	US
Telephone Number	:	786-406-9552
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	07/25/2017

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Directions to “ JUDITH DIAZ COTA” Practice Location

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