Healthcare Provider Details

I. General information

NPI: 1881713089
Provider Name (Legal Business Name): TOYYONKA LAVON SANDERS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 PARKINGWAY ST
QUINCY MA
02169-5020
US

IV. Provider business mailing address

16 ITHICA RD
BROCKTON MA
02302-4437
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-4222
  • Fax:
Mailing address:
  • Phone: 508-588-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2707
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: