Healthcare Provider Details

I. General information

NPI: 1922263870
Provider Name (Legal Business Name): JAMES H BROUILLET COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WESTSHORE BLVD STE 600
TAMPA FL
33609-1137
US

IV. Provider business mailing address

73 LONG MEADOW AVE
HAMDEN CT
06514-4329
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-2191
  • Fax:
Mailing address:
  • Phone: 203-382-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number000626
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: