Provider Demographics
NPI:1831462035
Name:COVIELLO, RYAN WILLIAM (COTA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:COVIELLO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-3304
Mailing Address - Country:US
Mailing Address - Phone:860-274-5428
Mailing Address - Fax:
Practice Address - Street 1:35 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-3304
Practice Address - Country:US
Practice Address - Phone:860-274-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000657224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant