Healthcare Provider Details

I. General information

NPI: 1124147160
Provider Name (Legal Business Name): KIMBERLY HAVENS HILL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E 95TH ST APARTMENT 11 L
NEW YORK NY
10128-4012
US

IV. Provider business mailing address

235 E 95TH ST APARTMENT 11 L
NEW YORK NY
10128-4012
US

V. Phone/Fax

Practice location:
  • Phone: 212-706-7303
  • Fax:
Mailing address:
  • Phone: 212-706-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number64 004513
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: