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NPI Code Detail

MEDICARE: MISS PRINCESS KEANNE O PINEDA COTA

MEDICARE: MISS PRINCESS KEANNE O PINEDA 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 Assistant46TA09135300NJ

General Provider Information

NPI Number : 1225865579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS PRINCESS KEANNE O PINEDA COTA
Provider Business Mailing Address
First Line : 1616 HAMILTON ST
Second Line :
City : BELLEVILLE
State : NJ
Zip : 07109-5346
Country : US
Telephone Number : 856-506-6281
Fax Number :
Provider Business Practice Location Address
First Line : 1616 HAMILTON ST
Second Line :
City : BELLEVILLE
State : NJ
Zip : 07109-5346
Country : US
Telephone Number : 856-506-6281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2024
Last Update Date : 09/18/2024

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