Provider Demographics
NPI:1215816319
Name:SANTOS, EDWIN (COTA)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:SANTOS
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 1:208 BRUSH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3025
Mailing Address - Country:US
Mailing Address - Phone:585-305-9302
Mailing Address - Fax:
Practice Address - Street 1:815 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-2320
Practice Address - Country:US
Practice Address - Phone:716-688-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011730224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant