=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467758524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLINE ALICE RINARD COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2011
-----------------------------------------------------
Last Update Date | 02/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2495 MAIN ST SUITE 234
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14214-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-836-5929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3363 SHIRLEY RD
-----------------------------------------------------
City | NORTH COLLINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14111-9733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-337-2607
-----------------------------------------------------
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 | 007617-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------