Healthcare Provider Details

I. General information

NPI: 1750208120
Provider Name (Legal Business Name): KEVIN PATRICK O'BRIEN JR. COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

25 GIBBENS ST
SOMERVILLE MA
02143-1504
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA4912
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: