MEDICARE: KRISTIN BIRCH 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	215480	TX

General Provider Information

NPI Number	:	1982256269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BIRCH COTA

Provider Business Mailing Address
First Line	:	12820 W PARMER LN APT 8203
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12820 W PARMER LN APT 8203
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7536
Country	:	US
Telephone Number	:	626-798-1557
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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