Healthcare Provider Details

I. General information

NPI: 1063703908
Provider Name (Legal Business Name): MARY ELIZABETH CAPUANO-YATES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DIXON AVE
CONCORD NH
03301-4944
US

IV. Provider business mailing address

2 DOGWOOD TER
PENACOOK NH
03303-3416
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-1551
  • Fax:
Mailing address:
  • Phone: 603-219-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0413
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: