Healthcare Provider Details

I. General information

NPI: 1033453402
Provider Name (Legal Business Name): MEGAN LYNN KINSELLA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2012
Last Update Date: 11/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GARY L MAIETTA PKWY UNIT 16
SOUTH PORTLAND ME
04106-7818
US

IV. Provider business mailing address

60 GARY L MAIETTA PKWY UNIT 16
SOUTH PORTLAND ME
04106-7818
US

V. Phone/Fax

Practice location:
  • Phone: 207-518-9290
  • Fax:
Mailing address:
  • Phone: 207-518-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA2687
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: