Healthcare Provider Details

I. General information

NPI: 1649304916
Provider Name (Legal Business Name): JEANINE M KUPER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CENTER ST
GOFFSTOWN NH
03045-2948
US

IV. Provider business mailing address

37 BIRCHWOOD CIR
BEDFORD NH
03110-4911
US

V. Phone/Fax

Practice location:
  • Phone: 603-497-4128
  • Fax: 603-497-4085
Mailing address:
  • Phone: 603-472-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number536
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: