Healthcare Provider Details

I. General information

NPI: 1396289740
Provider Name (Legal Business Name): KATHLEEN FOSTER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DEERING AVE APT. 2
PORTLAND ME
04101-2292
US

IV. Provider business mailing address

1924 GILPIN AVE
WILMINGTON DE
19806-2308
US

V. Phone/Fax

Practice location:
  • Phone: 610-716-5320
  • Fax:
Mailing address:
  • Phone: 610-716-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA3257
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberU2-0001852
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: