Healthcare Provider Details

I. General information

NPI: 1942758057
Provider Name (Legal Business Name): NICOLE ATTIVISSIMO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 S WOODS RD
WOODBURY NY
11797-1024
US

IV. Provider business mailing address

4 PAUL REVERE LN
CENTERPORT NY
11721-1610
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-7650
  • Fax:
Mailing address:
  • Phone: 631-902-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: