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General NPI Number Information
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NPI Number | 1457976391
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Entity Type | Individual
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Provider Name | GRACE LYNN MCLEAN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 7 HIGHWOOD ST
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City | WATERVILLE
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State | ME
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Zip | 04901-5739
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Country | US
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Telephone | 207-873-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 897 CHINA RD
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City | WINSLOW
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State | ME
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Zip | 04901-0318
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Country | US
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Telephone | 207-751-7014
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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 | 0831
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License Number State | NH
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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 | OA3810
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License Number State | ME
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