=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417253964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA MARVINNEY COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2011
-----------------------------------------------------
Last Update Date | 02/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 ROUTE 302
-----------------------------------------------------
City | PINE BUSH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-744-2031
-----------------------------------------------------
Fax | 845-744-6189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 MONAHAN RD.
-----------------------------------------------------
City | PORT JERVIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-856-3525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 003430-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------