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General NPI Number Information
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NPI Number | 1285918243
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Entity Type | Individual
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Provider Name | NICOLE K CRAVOTTA COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2719
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Country | US
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Telephone | 505-272-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 PENNSYLVANIA ST NE UNIT A07
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5504
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Country | US
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Telephone | 234-806-1046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA. 3104
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 12260
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA4360
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License Number State | NM
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