Healthcare Provider Details

I. General information

NPI: 1669889598
Provider Name (Legal Business Name): KEVIN COTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 WEST BOYLSTON STREET
WORCESTER MA
01606
US

IV. Provider business mailing address

799 WEST BOYLSTON STREET
WORCESTER MA
01606
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-4032
  • Fax:
Mailing address:
  • Phone: 413-586-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number11266
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: