Healthcare Provider Details

I. General information

NPI: 1215272315
Provider Name (Legal Business Name): DEBRA COTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2012
Last Update Date: 12/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 PRATT CORNER RD
SHUTESBURY MA
01072-9718
US

IV. Provider business mailing address

64 PRATT CORNER RD
SHUTESBURY MA
01072-9718
US

V. Phone/Fax

Practice location:
  • Phone: 413-259-2110
  • Fax:
Mailing address:
  • Phone: 413-259-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2989
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: