Healthcare Provider Details

I. General information

NPI: 1023224748
Provider Name (Legal Business Name): PATRICIA ANN VANHOUDT COTA L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 POND BROOK RD
WEST CHESTERFIELD NH
03466-3504
US

IV. Provider business mailing address

195 POND BROOK RD
WEST CHESTERFIELD NH
03466-3504
US

V. Phone/Fax

Practice location:
  • Phone: 603-256-8804
  • Fax:
Mailing address:
  • Phone: 603-256-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0518
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: