Healthcare Provider Details

I. General information

NPI: 1336249085
Provider Name (Legal Business Name): ANNE GRETCHEN KAHERL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

616 OLD LEWISTON RD
WINTHROP ME
04364-4119
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax: 207-621-7393
Mailing address:
  • Phone: 207-623-8411
  • Fax: 207-621-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA63
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: