Healthcare Provider Details

I. General information

NPI: 1659867869
Provider Name (Legal Business Name): CADY MAREE TETREAULT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAPLE ST STE 410
MARLBOROUGH MA
01752-3200
US

IV. Provider business mailing address

4 KEENAN RD APT 4
NORTH ATTLEBORO MA
02760-2918
US

V. Phone/Fax

Practice location:
  • Phone: 508-624-0304
  • Fax:
Mailing address:
  • Phone: 508-404-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2319
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number2319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: