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NPI Code Detail

MEDICARE: MRS. KIMBERLY SUE PERCHALUK COTA

MEDICARE: MRS. KIMBERLY SUE PERCHALUK 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
1224Z00000XOccupational Therapy Assistant003733-1NY

General Provider Information

NPI Number : 1215204250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY SUE PERCHALUK COTA
Provider Business Mailing Address
First Line : 1397 ORCHARD PARK RD
Second Line :
City : WEST SENECA
State : NY
Zip : 14224-4029
Country : US
Telephone Number : 716-677-3532
Fax Number : 716-674-1046
Provider Business Practice Location Address
First Line : 1397 ORCHARD PARK RD
Second Line :
City : WEST SENECA
State : NY
Zip : 14224-4029
Country : US
Telephone Number : 716-677-3532
Fax Number : 716-674-1046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2011
Last Update Date : 11/18/2011

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