Healthcare Provider Details

I. General information

NPI: 1790083772
Provider Name (Legal Business Name): DANIEL H DAHLKE COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CHATEAU TER
AMHERST NY
14226-3927
US

IV. Provider business mailing address

25 CHATEAU TER
AMHERST NY
14226-3927
US

V. Phone/Fax

Practice location:
  • Phone: 716-839-1655
  • Fax: 716-839-1656
Mailing address:
  • Phone: 716-839-1655
  • Fax: 716-836-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number002896-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number002896-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: