Healthcare Provider Details

I. General information

NPI: 1770173551
Provider Name (Legal Business Name): CARLEEN TABLER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WALL ST APT 210
NORWALK CT
06850-3434
US

IV. Provider business mailing address

10 WALL ST APT 210
NORWALK CT
06850-3434
US

V. Phone/Fax

Practice location:
  • Phone: 740-440-0182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2369
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: