MEDICARE: COURTNEY RENAY RUIZ COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	209858	TX

General Provider Information

NPI Number	:	1023296860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY RENAY RUIZ COTA

Provider Business Mailing Address
First Line	:	4507 LAKE PARK DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4507 LAKE PARK DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2807
Country	:	US
Telephone Number	:	936-332-5298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	07/20/2022

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