Provider Demographics
NPI:1396981015
Name:PHILLIPS, CAROL MARY (COTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARY
Last Name:PHILLIPS
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 1:1330 PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-2810
Mailing Address - Country:US
Mailing Address - Phone:518-377-6283
Mailing Address - Fax:
Practice Address - Street 1:1330 PAUL AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-2810
Practice Address - Country:US
Practice Address - Phone:518-377-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist