Healthcare Provider Details

I. General information

NPI: 1285958660
Provider Name (Legal Business Name): AMARYLLIS AMANDA SANCHEZ COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CLANTOY ST
SPRINGFIELD MA
01104-2446
US

IV. Provider business mailing address

60 CLANTOY ST
SPRINGFIELD MA
01104-2446
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-8450
  • Fax:
Mailing address:
  • Phone: 413-732-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: