Healthcare Provider Details

I. General information

NPI: 1528796661
Provider Name (Legal Business Name): CANDYCE PUGLIO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LOCUST ST SUITE #333
DOVER NH
03820
US

IV. Provider business mailing address

14 OAKWOODS RD
NORTH BERWICK ME
03906
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-3534
  • Fax: 405-366-0010
Mailing address:
  • Phone: 860-459-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA4375
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0898
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: