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General NPI Number Information
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NPI Number | 1891003448
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Entity Type | Individual
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Provider Name | JEROME W BRADIGAN COTA/L
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Gender | Male
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 425 E MAIN ST
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City | FREDONIA
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State | NY
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Zip | 14063-1451
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Country | US
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Telephone | 716-679-1581
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Fax | 716-679-9043
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Provider Business Mailing Address
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Address Line | 10 HOLMES PL
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City | FREDONIA
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State | NY
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Zip | 14063-1214
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Country | US
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Telephone | 716-672-7723
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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 | 005572-1
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License Number State | NY
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