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General NPI Number Information
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NPI Number | 1821623539
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Entity Type | Individual
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Provider Name | TAKEEMA I JOSEPH COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 43 CLARIDGE AVE FL 2
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City | ELMONT
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State | NY
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Zip | 11003-1556
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Country | US
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Telephone | 516-502-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 MCCLELLAN ST APT 2
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City | SCHENECTADY
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State | NY
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Zip | 12309-5627
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Country | US
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Telephone | 518-772-9590
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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 | 009181
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License Number State | NY
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