Healthcare Provider Details

I. General information

NPI: 1255889390
Provider Name (Legal Business Name): MAUREEN MCGRADE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 MT HOPE RD
MIDDLETOWN NY
10940-7135
US

IV. Provider business mailing address

15 SECOND ST
CORNWALL ON HUDSON NY
12520-1312
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-2292
  • Fax:
Mailing address:
  • Phone: 845-270-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009051-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: