Healthcare Provider Details

I. General information

NPI: 1356466544
Provider Name (Legal Business Name): CECILY LYN REMY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N MAIN ST
S YARMOUTH MA
02664-2083
US

IV. Provider business mailing address

1051 NEW BOSTON RD
FALL RIVER MA
02720
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-3514
  • Fax:
Mailing address:
  • Phone: 508-837-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2163
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: