Healthcare Provider Details

I. General information

NPI: 1245547256
Provider Name (Legal Business Name): PATRICIA ANN JOSEPHSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MAIN ST
DUNKIRK NY
14048-2720
US

IV. Provider business mailing address

2435 ROEMER RD
ASHVILLE NY
14710-9686
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-3417
  • Fax: 716-366-3568
Mailing address:
  • Phone: 716-763-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number64 007639
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: