Healthcare Provider Details

I. General information

NPI: 1265685747
Provider Name (Legal Business Name): CYNTHIA LYNN CRAINE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 NYE RD
LYONS NY
14489-9111
US

IV. Provider business mailing address

159 W 1ST ST
OSWEGO NY
13126-2045
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5673
  • Fax: 315-946-5850
Mailing address:
  • Phone: 315-342-9575
  • Fax: 315-342-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number002170-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: