Healthcare Provider Details

I. General information

NPI: 1770293045
Provider Name (Legal Business Name): JUSTIN JAMES PLOW COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ALLENS CREEK RD STE 1
ROCHESTER NY
14618-3253
US

IV. Provider business mailing address

2766 RIDGEWAY AVE
ROCHESTER NY
14626-4211
US

V. Phone/Fax

Practice location:
  • Phone: 585-461-6225
  • Fax: 585-461-6228
Mailing address:
  • Phone: 585-857-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number484308
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: