Healthcare Provider Details

I. General information

NPI: 1114043767
Provider Name (Legal Business Name): DAVID J. BOYLE COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WILLIAM ST.
SPRINGFIELD MA
01105
US

IV. Provider business mailing address

136 WILLIAM ST.
SPRINGFIELD MA
01105
US

V. Phone/Fax

Practice location:
  • Phone: 413-788-2171
  • Fax:
Mailing address:
  • Phone: 413-788-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2017
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: