MEDICARE: DONNA LYNN MAGGIO 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	225XP0200X	Pediatric Occupational Therapist	008194-1	NY

General Provider Information

NPI Number	:	1225379530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA LYNN MAGGIO COTA

Provider Business Mailing Address
First Line	:	6 WIERK AVE
Second Line	:
City	:	LIBERTY
State	:	NY
Zip	:	12754-2117
Country	:	US
Telephone Number	:	845-295-4000
Fax Number	:	845-292-8694

Provider Business Practice Location Address
First Line	:	29 SCHOOLHOUSE RD
Second Line	:
City	:	WHITE SULPHUR SPRINGS
State	:	NY
Zip	:	12787
Country	:	US
Telephone Number	:	845-295-4000
Fax Number	:	845-292-8694

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

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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