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General NPI Number Information
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NPI Number | 1427692383
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Entity Type | Individual
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Provider Name | DOUGLAS A HALLAM COTA/L
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Gender | Male
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 2700 WESTCHESTER AVE STE 300
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City | PURCHASE
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State | NY
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Zip | 10577-2554
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Country | US
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Telephone | 914-323-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 46 PETERSON CT
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City | PEARL RIVER
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State | NY
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Zip | 10965-2865
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Country | US
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Telephone | 845-558-0185
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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 | 010228
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License Number State | NY
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