Healthcare Provider Details

I. General information

NPI: 1255713970
Provider Name (Legal Business Name): BRIAN JOHNSON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 HIGH ST
CLAREMONT NH
03743-2720
US

IV. Provider business mailing address

67 HIGH ST
CLAREMONT NH
03743-2720
US

V. Phone/Fax

Practice location:
  • Phone: 603-558-8450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: