=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447725452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEBA BETH RABINOWITZ COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2018
-----------------------------------------------------
Last Update Date | 10/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2221 RICHMOND AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-3920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-475-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 186 VASSAR ST UNIT 2
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-586-0143
-----------------------------------------------------
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 | 008919
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------