Provider Demographics
NPI:1306181102
Name:ADAMS, MARY FATIMA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FATIMA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:FATIMA
Other - Last Name:GOULART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:75 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4472
Mailing Address - Country:US
Mailing Address - Phone:401-272-5280
Mailing Address - Fax:505-468-3550
Practice Address - Street 1:75 EAST ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4472
Practice Address - Country:US
Practice Address - Phone:401-272-5280
Practice Address - Fax:505-468-3550
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant