Healthcare Provider Details

I. General information

NPI: 1861602138
Provider Name (Legal Business Name): MARIE JENNIE O'CONNOR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BRICKSTONE SQ
ANDOVER MA
01810-1437
US

IV. Provider business mailing address

57 SOUTHWICK RD
NORTH READING MA
01864-2113
US

V. Phone/Fax

Practice location:
  • Phone: 978-474-7500
  • Fax:
Mailing address:
  • Phone: 978-664-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number741
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: