MEDICARE: JACQUELINE M COLLINS COTA/L

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	011738	NY

General Provider Information

NPI Number	:	1487505400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE M COLLINS COTA/L

Provider Business Mailing Address
First Line	:	210 NEW RD
Second Line	:
City	:	MONTAGUE
State	:	NJ
Zip	:	07827-3418
Country	:	US
Telephone Number	:	845-499-8030
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 NEW RD
Second Line	:
City	:	MONTAGUE
State	:	NJ
Zip	:	07827-3418
Country	:	US
Telephone Number	:	845-499-8030
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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