Healthcare Provider Details

I. General information

NPI: 1134154990
Provider Name (Legal Business Name): DEBBIE CUNNINGHAM LESTER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

IV. Provider business mailing address

11 EAST CENTER STREET
ANDOVER NY
14806
US

V. Phone/Fax

Practice location:
  • Phone: 585-596-4011
  • Fax:
Mailing address:
  • Phone: 607-478-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number004627-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: