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General NPI Number Information
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NPI Number | 1821866872
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Entity Type | Individual
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Provider Name | JENNIE KIRKWOOD COTA
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Gender | Female
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 380 DRAKE DR
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-1646
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Country | US
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Telephone | 716-807-3725
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Fax |
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Provider Business Mailing Address
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Address Line | 23 CHIPMAN PL
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-4305
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Country | US
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Telephone |
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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 | 007395-01
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License Number State | NY
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