Healthcare Provider Details

I. General information

NPI: 1548511389
Provider Name (Legal Business Name): MICHELE PETTENATI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 OCONNOR ST
WELLSVILLE NY
14895-1021
US

IV. Provider business mailing address

53 OCONNOR ST
WELLSVILLE NY
14895-1021
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-4420
  • Fax:
Mailing address:
  • Phone: 585-593-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: