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General NPI Number Information
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NPI Number | 1902173727
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Entity Type | Individual
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Provider Name | DIANE ELIZABETH CUILLO COTA
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Gender | Female
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 35 CARMAN RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5651
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Country | US
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Telephone | 631-549-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 140 CAMBON AVE
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City | SAINT JAMES
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State | NY
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Zip | 11780-3042
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Country | US
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Telephone | 631-724-6398
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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 | 000496-1
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License Number State | NY
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