Healthcare Provider Details

I. General information

NPI: 1073299525
Provider Name (Legal Business Name): CAISSY J PRICE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MAIN ST # A
FARMINGTON CT
06032-2985
US

IV. Provider business mailing address

304 MAIN ST # A
FARMINGTON CT
06032-2985
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-1824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number001689
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: