Provider Demographics
NPI:1063657161
Name:LA FATA, GERALANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:GERALANN
Middle Name:
Last Name:LA FATA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NICOLE CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2910
Mailing Address - Country:US
Mailing Address - Phone:631-325-2021
Mailing Address - Fax:631-325-2021
Practice Address - Street 1:8 NICOLE CT
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2910
Practice Address - Country:US
Practice Address - Phone:631-325-2021
Practice Address - Fax:631-325-2021
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005211-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant