Healthcare Provider Details

I. General information

NPI: 1053035667
Provider Name (Legal Business Name): AMANDA DANIELLE CULL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ISLAND COTTAGE RD
GREECE NY
14612-2312
US

IV. Provider business mailing address

585 WILKINSON RD
MACEDON NY
14502-8809
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6100
  • Fax:
Mailing address:
  • Phone: 315-694-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: