Healthcare Provider Details

I. General information

NPI: 1831489285
Provider Name (Legal Business Name): BEATRICE L HENRIKSSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 GREENWAY DR. VERNON HOUSE
VERNON VT
05354-9474
US

IV. Provider business mailing address

PO BOX 445
GLENMONT NY
12077-0445
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-6041
  • Fax:
Mailing address:
  • Phone: 518-396-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number073.0075595
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: