MEDICARE: JAQUELINE FERRER 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
1	224Z00000X	Occupational Therapy Assistant	09584-1	NY

General Provider Information

NPI Number	:	1750940813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUELINE FERRER COTA/L

Provider Business Mailing Address
First Line	:	141 E PIERREPONT AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2417
Country	:	US
Telephone Number	:	201-362-0462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1594 TOWNSEND AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-5904
Country	:	US
Telephone Number	:	718-299-3917
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/11/2019

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