Healthcare Provider Details

I. General information

NPI: 1104585116
Provider Name (Legal Business Name): MARISSA MARIE ZABRISKIE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH ST
HARTFORD CT
06110-1967
US

IV. Provider business mailing address

101 SOUTH ST FL 2
HARTFORD CT
06110-1967
US

V. Phone/Fax

Practice location:
  • Phone: 860-578-1300
  • Fax:
Mailing address:
  • Phone: 860-670-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2183
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4782
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: