Healthcare Provider Details

I. General information

NPI: 1790909133
Provider Name (Legal Business Name): KIMBERLY ELLEN GAIPO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLEASANT ST
CONCORD NH
03301-7504
US

IV. Provider business mailing address

883 WEIRS BLVD UNIT 44
LACONIA NH
03246-1637
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-6561
  • Fax: 603-224-8530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0492
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: