Healthcare Provider Details

I. General information

NPI: 1972686426
Provider Name (Legal Business Name): LISA MARIE HAHNE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LAURA LN
OTISVILLE NY
10963-2318
US

IV. Provider business mailing address

3 LAURA LN
OTISVILLE NY
10963-2318
US

V. Phone/Fax

Practice location:
  • Phone: 845-386-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP005904
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005944-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: