MEDICARE: KENDRA THOMAS CRILL 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	211392	TX

General Provider Information

NPI Number	:	1720335763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA THOMAS CRILL COTA

Provider Business Mailing Address
First Line	:	6060 N CENTRAL EXPY
Second Line	:	SUITE 460
City	:	DALLAS
State	:	TX
Zip	:	75206-5209
Country	:	US
Telephone Number	:	214-414-2888
Fax Number	:	888-215-2994

Provider Business Practice Location Address
First Line	:	2501 MAPLE AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-1337
Country	:	US
Telephone Number	:	972-479-5368
Fax Number	:	888-215-2994

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

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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