Healthcare Provider Details

I. General information

NPI: 1215025499
Provider Name (Legal Business Name): DEBRA MARTIN COTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 WESTERN AVENUE
AUGUSTA ME
04330
US

IV. Provider business mailing address

538 WESTERN AVENUE
AUGUSTA ME
04330
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-1125
  • Fax: 207-626-9357
Mailing address:
  • Phone: 207-621-1125
  • Fax: 207-626-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA1572
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: