Healthcare Provider Details

I. General information

NPI: 1376151357
Provider Name (Legal Business Name): PAUL CIPRIANO COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 NORWOOD AVE
CRANSTON RI
02905-3923
US

IV. Provider business mailing address

178 NORWOOD AVE
CRANSTON RI
02905-3923
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-1470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA01006
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: