Provider Demographics
NPI:1679082879
Name:COUTO, KEVIN RYAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RYAN
Last Name:COUTO
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COLD BROOK LN
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1301
Mailing Address - Country:US
Mailing Address - Phone:774-271-2329
Mailing Address - Fax:
Practice Address - Street 1:233 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4840
Practice Address - Country:US
Practice Address - Phone:781-843-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00958224Z00000X
MA4175224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant