Healthcare Provider Details

I. General information

NPI: 1861526212
Provider Name (Legal Business Name): JENNIFER GARCIA 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

1515 LAMBERTS MILL RD
WESTFIELD NJ
07090-4763
US

IV. Provider business mailing address

40 FAYETTE ST APT 30
PERTH AMBOY NJ
08861-4245
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-9700
  • Fax:
Mailing address:
  • Phone: 908-377-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09014100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: