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NPI Code Detail

MEDICARE: MR. MICHAEL CARRINGTON LANE COTA/L

MEDICARE: MR. MICHAEL CARRINGTON LANE COTA/L
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
1224Z00000XOccupational Therapy Assistant009251-1NY

General Provider Information

NPI Number : 1104344795
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL CARRINGTON LANE COTA/L
Provider Business Mailing Address
First Line : 79 WESTCHESTER SQ APT 2F
Second Line :
City : BRONX
State : NY
Zip : 10461-3546
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 550 WHITE PLAINS RD
Second Line :
City : EASTCHESTER
State : NY
Zip : 10709-5506
Country : US
Telephone Number : 914-793-6130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2017
Last Update Date : 09/02/2017

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