Healthcare Provider Details

I. General information

NPI: 1184918146
Provider Name (Legal Business Name): CATHLEEN MARY SEXTON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2147
US

IV. Provider business mailing address

18 IRIS AVE APT 3
FLORAL PARK NY
11001-2735
US

V. Phone/Fax

Practice location:
  • Phone: 516-459-0128
  • Fax:
Mailing address:
  • Phone: 516-326-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006282-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: