Healthcare Provider Details

I. General information

NPI: 1871750489
Provider Name (Legal Business Name): ADAM DUVALL COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PARKWAY S
BREWER ME
04412-1628
US

IV. Provider business mailing address

31 JOE AVE
WINSLOW ME
04901-7128
US

V. Phone/Fax

Practice location:
  • Phone: 207-989-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA1796
License Number StateME

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: