Healthcare Provider Details

I. General information

NPI: 1528972122
Provider Name (Legal Business Name): JOHN WILLIAM WATTERS COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SOUTHFIELD AVE
BROOKFIELD CT
06804-1922
US

IV. Provider business mailing address

2 MEADOW BROOK RD
BROOKFIELD CT
06804-1922
US

V. Phone/Fax

Practice location:
  • Phone: 475-303-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2398
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: