Healthcare Provider Details

I. General information

NPI: 1548997570
Provider Name (Legal Business Name): ALYSSA MAAS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MARYVALE DR
CHEEKTOWAGA NY
14225-2324
US

IV. Provider business mailing address

350 CENTRAL AVE APT C1
FREDONIA NY
14063-1144
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-0300
  • Fax:
Mailing address:
  • Phone: 716-640-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: