Healthcare Provider Details

I. General information

NPI: 1730581786
Provider Name (Legal Business Name): LISA LIQUORI COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HIGHLAND ST
FEEDING HILLS MA
01030-2214
US

IV. Provider business mailing address

84 HIGHLAND ST
FEEDING HILLS MA
01030-2214
US

V. Phone/Fax

Practice location:
  • Phone: 413-537-7992
  • Fax:
Mailing address:
  • Phone: 413-537-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: