Healthcare Provider Details

I. General information

NPI: 1114078870
Provider Name (Legal Business Name): AMY MARIE THORNE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARIE LEONE COTA

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

68 HARVEY DR
LANCASTER NY
14086-2812
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3803
  • Fax:
Mailing address:
  • Phone: 716-684-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number003350-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: