MEDICARE: KATHLEEN DOUGHTY COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	008172-1	NY

General Provider Information

NPI Number	:	1063846608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN DOUGHTY COTA

Provider Business Mailing Address
First Line	:	330 PRIMROSE HILL RD
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-2667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 PRIMROSE HILL RD
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-2667
Country	:	US
Telephone Number	:	845-269-7054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2013
Last Update Date	:	08/31/2013

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