Provider Demographics
NPI:1487211892
Name:HART, DAVID R (COTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HART
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4220 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1185
Mailing Address - Country:US
Mailing Address - Phone:518-892-4201
Mailing Address - Fax:
Practice Address - Street 1:180 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5304
Practice Address - Country:US
Practice Address - Phone:518-456-7831
Practice Address - Fax:518-456-1563
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant