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General NPI Number Information
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NPI Number | 1477004414
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Entity Type | Individual
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Provider Name | SUZANNE MARIE DAVIS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 15 HASSON ST
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City | FARMINGDALE
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State | ME
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Zip | 04344-1613
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Country | US
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Telephone | 207-588-7692
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Fax | 207-588-7693
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Provider Business Mailing Address
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Address Line | 15 HASSON ST
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City | FARMINGDALE
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State | ME
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Zip | 04344-1613
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Country | US
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Telephone | 207-588-7692
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Fax | 207-588-7693
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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 | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | OA3184
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License Number State | ME
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