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NPI Code Detail

MEDICARE: MRS. STACEY LORRAINE AMARAL COTA/ L

MEDICARE: MRS. STACEY LORRAINE AMARAL 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
1224Z00000XOccupational Therapy Assistant1940MA

General Provider Information

NPI Number : 1598964058
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEY LORRAINE AMARAL COTA/ L
Provider Business Mailing Address
First Line : 347 SOMERVILLE AVE
Second Line :
City : SOMERVILLE
State : MA
Zip : 02143-2914
Country : US
Telephone Number : 617-201-6076
Fax Number :
Provider Business Practice Location Address
First Line : 347 SOMERVILLE AVE
Second Line :
City : SOMERVILLE
State : MA
Zip : 02143-2914
Country : US
Telephone Number : 617-201-6076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2007
Last Update Date : 07/15/2007

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Directions to “ MRS. STACEY LORRAINE AMARAL COTA/ L” Practice Location

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