Healthcare Provider Details

I. General information

NPI: 1629746839
Provider Name (Legal Business Name): HOLLYANN KATHERINE BRYANT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NAGEL DR
CHEEKTOWAGA NY
14225-3818
US

IV. Provider business mailing address

1801 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-2249
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-7471
  • Fax:
Mailing address:
  • Phone: 716-773-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number010772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: