Provider Demographics
NPI:1629360177
Name:COHEN, BERTHA ELSA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:ELSA
Last Name:COHEN
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 1:6 SAHALEE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4041
Mailing Address - Country:US
Mailing Address - Phone:732-616-7343
Mailing Address - Fax:
Practice Address - Street 1:6 SAHALEE CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4041
Practice Address - Country:US
Practice Address - Phone:732-616-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09015000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant