Healthcare Provider Details

I. General information

NPI: 1821203753
Provider Name (Legal Business Name): NICOLE LEE VAN ORDEN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 WASHINGTON STREET
COLUMBIA NJ
07832
US

IV. Provider business mailing address

932 CEDAR DR
NEWTON NJ
07860-4517
US

V. Phone/Fax

Practice location:
  • Phone: 908-496-4307
  • Fax:
Mailing address:
  • Phone: 973-534-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: