Healthcare Provider Details

I. General information

NPI: 1578225819
Provider Name (Legal Business Name): DANIELLE R MAGNANT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 GREENWAY
VERNON VT
05354-9474
US

IV. Provider business mailing address

360 HIGLEY HILL RD
WILMINGTON VT
05363-9614
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-6041
  • Fax: 802-257-5362
Mailing address:
  • Phone: 802-780-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number073.000133
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: