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General NPI Number Information
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NPI Number | 1750657300
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Entity Type | Individual
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Provider Name | AMANDA MARIE LANCTOT COTA
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Gender | Female
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 134 THURBERS AVE
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City | PROVIDENCE
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State | RI
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Zip | 02905
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Country | US
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Telephone | 401-270-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 157 CAMPEAU ST.
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City | WOONSOCKET
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State | RI
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Zip | 02895
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Country | US
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Telephone | 401-765-4792
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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 | OTA00509
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License Number State | RI
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