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General NPI Number Information
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NPI Number | 1811626104
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Entity Type | Individual
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Provider Name | MICHELE OBRIEN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 6308 69TH PL
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1726
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Country | US
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Telephone | 917-299-3755
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Fax |
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Provider Business Mailing Address
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Address Line | 7 WESTERLY AVE
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City | BETHPAGE
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State | NY
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Zip | 11714-2913
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Country | US
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Telephone | 917-299-3755
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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 | 01015101
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License Number State | NY
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