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General NPI Number Information
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NPI Number | 1578602926
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Entity Type | Individual
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Provider Name | JENNIFER MARY SOFIA COTA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 200 OLD FARMINGDALE RD
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City | WEST BABYLON
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State | NY
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Zip | 11704-6508
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Country | US
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Telephone | 631-376-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 169 N DELAWARE AVE
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City | LINDENHURST
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State | NY
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Zip | 11757-4145
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Country | US
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Telephone | 631-807-4010
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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 | 006275-1
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License Number State | NY
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