Healthcare Provider Details

I. General information

NPI: 1154562437
Provider Name (Legal Business Name): SUSAN MARIE KURGAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MAIN STREET OCCUPATIONAL THERAPY & HAND REHAB.
DUNKIRK NY
14048-2920
US

IV. Provider business mailing address

47 RISLEY STREET
FREDONIA NY
14063-2720
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-3417
  • Fax: 716-366-3568
Mailing address:
  • Phone: 716-366-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number007276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: