Healthcare Provider Details

I. General information

NPI: 1275232134
Provider Name (Legal Business Name): DANIELLE WUNSCHEL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78B FOREST ST
WAKEFIELD MA
01880-3635
US

IV. Provider business mailing address

78B FOREST ST
WAKEFIELD MA
01880-3635
US

V. Phone/Fax

Practice location:
  • Phone: 774-473-0943
  • Fax:
Mailing address:
  • Phone: 774-473-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3826
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: