Healthcare Provider Details

I. General information

NPI: 1679931174
Provider Name (Legal Business Name): PATRICIA WELCH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WILLIAM ST
SPRINGFIELD MA
01105-2324
US

IV. Provider business mailing address

136 WILLIAM ST
SPRINGFIELD MA
01105-2324
US

V. Phone/Fax

Practice location:
  • Phone: 401-954-4950
  • Fax:
Mailing address:
  • Phone: 401-954-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA00820
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: