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General NPI Number Information
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NPI Number | 1831387554
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Entity Type | Individual
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Provider Name | CYNTHIA M PETTY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 333 GREEN END AVE
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City | MIDDLETOWN
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State | RI
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Zip | 02842-5620
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Country | US
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Telephone | 508-728-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 SPENCER ST
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City | FALL RIVER
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State | MA
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Zip | 02721-4544
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Country | US
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Telephone | 508-678-6245
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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 | OTA00109
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1967
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License Number State | MA
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