Healthcare Provider Details

I. General information

NPI: 1295672467
Provider Name (Legal Business Name): REBECCA VAUGHN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA BLUMBERGS

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 CURRY RD EXT
SCHENECTADY NY
12303-2801
US

IV. Provider business mailing address

615 GROOMS RD
CLIFTON PARK NY
12065-5912
US

V. Phone/Fax

Practice location:
  • Phone: 518-836-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number010381-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: