Healthcare Provider Details

I. General information

NPI: 1851972897
Provider Name (Legal Business Name): DIANE SULLIVAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOVE LN
SOUTH DENNIS MA
02660-3445
US

IV. Provider business mailing address

76 TUPPER RD UNIT 1
SANDWICH MA
02563-2075
US

V. Phone/Fax

Practice location:
  • Phone: 508-385-6034
  • Fax:
Mailing address:
  • Phone: 203-565-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number000873
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4326
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: