Healthcare Provider Details

I. General information

NPI: 1003633868
Provider Name (Legal Business Name): TATIANA FRANCESCA BRUNO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 RTE 46 STE 15-205
ROCKAWAY NJ
07866-4046
US

IV. Provider business mailing address

26 FREMONT ST APT 2
MONTCLAIR NJ
07042-2410
US

V. Phone/Fax

Practice location:
  • Phone: 973-461-9319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TA0924780
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: