Healthcare Provider Details

I. General information

NPI: 1225373160
Provider Name (Legal Business Name): MICHAEL KONSTAN COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 WILBRAHAM RD
SPRINGFIELD MA
01109-2067
US

IV. Provider business mailing address

10 CORDNER RD
BELCHERTOWN MA
01007-9491
US

V. Phone/Fax

Practice location:
  • Phone: 413-782-1800
  • Fax:
Mailing address:
  • Phone: 413-323-5889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: