MEDICARE: HUNTER EDWARD MALL 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	011568	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011568	OTHER	NY	NEW YORK STATE LICENSE

General Provider Information

NPI Number	:	1912742859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER EDWARD MALL COTA

Provider Business Mailing Address
First Line	:	264 JEFFERSONVILLE NORTH BRANCH RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	NY
Zip	:	12748-5624
Country	:	US
Telephone Number	:	845-796-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 JEFFERSONVILLE NORTH BRANCH RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	NY
Zip	:	12748-5624
Country	:	US
Telephone Number	:	845-796-8200
Fax Number	:

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

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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