MEDICARE: IVET JIMENEZ 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	213104	TX

General Provider Information

NPI Number	:	1134607526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVET JIMENEZ COTA

Provider Business Mailing Address
First Line	:	17414 BARONSHIRE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17414 BARONSHIRE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1868
Country	:	US
Telephone Number	:	786-587-6826
Fax Number	:

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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