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General NPI Number Information
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NPI Number | 1386853588
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Entity Type | Individual
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Provider Name | TRACY ROBYN BORDEAU COTA
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 225 WYOMING AVE
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City | TORRINGTON
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State | CT
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Zip | 06790-6043
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Country | US
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Telephone | 860-482-8563
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Fax | 860-489-3848
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Provider Business Mailing Address
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Address Line | 3 OAKDALE RD
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City | TERRYVILLE
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State | CT
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Zip | 06786-4411
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Country | US
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Telephone | 860-589-7054
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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 | 03236865
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License Number State | CT
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