Healthcare Provider Details

I. General information

NPI: 1225157282
Provider Name (Legal Business Name): CATHERINE JOAN MESTEMAKER-HARRIS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BABCOCK AVE
PLAINFIELD CT
06374-1226
US

IV. Provider business mailing address

94 FLAT ROCK RD
PLAINFIELD CT
06374-2132
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-3387
  • Fax:
Mailing address:
  • Phone: 860-564-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000677
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: