Healthcare Provider Details

I. General information

NPI: 1053786400
Provider Name (Legal Business Name): ILEAN ESTER WOODS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VAN BUREN ST
NEWARK NY
14513-1238
US

IV. Provider business mailing address

1251 94TH ST
NIAGARA FALLS NY
14304-2610
US

V. Phone/Fax

Practice location:
  • Phone: 315-331-0566
  • Fax:
Mailing address:
  • Phone: 716-298-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number003018-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: