Healthcare Provider Details

I. General information

NPI: 1902952468
Provider Name (Legal Business Name): MICHAEL F MCADAMS COTAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ALLENS AVE 2ND FLOOR
PROVIDENCE RI
02905-5443
US

IV. Provider business mailing address

145 WILLETT AVE
RIVERSIDE RI
02915-4226
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-6800
  • Fax: 401-432-6832
Mailing address:
  • Phone: 401-433-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA00036
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: