Healthcare Provider Details

I. General information

NPI: 1386768687
Provider Name (Legal Business Name): REBECCA COVER CIRILLO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COOL ST
WATERVILLE ME
04901-5221
US

IV. Provider business mailing address

16 RIDGE RD
WATERVILLE ME
04901-4121
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-0721
  • Fax:
Mailing address:
  • Phone: 207-872-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA1737
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: