Healthcare Provider Details

I. General information

NPI: 1467312983
Provider Name (Legal Business Name): MELISSA BUBAR COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 S COUNTY TRL
WEST KINGSTON RI
02892-1829
US

IV. Provider business mailing address

3773 S COUNTY TRL
WEST KINGSTON RI
02892-1829
US

V. Phone/Fax

Practice location:
  • Phone: 401-318-6993
  • Fax:
Mailing address:
  • Phone: 401-318-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberRIOTA01348
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: