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NPI Code Detail

MEDICARE: JEANIE JOE-BLACK COTA

MEDICARE: JEANIE JOE-BLACK 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
1224Z00000XOccupational Therapy Assistant208845TX

General Provider Information

NPI Number : 1861972275
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANIE JOE-BLACK COTA
Provider Business Mailing Address
First Line : 23623 CERTOSA DR
Second Line :
City : RICHMOND
State : TX
Zip : 77406-5485
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3640 HAMPTON DR
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-3016
Country : US
Telephone Number : 281-778-5144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2018
Last Update Date : 08/15/2018

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Directions to “ JEANIE JOE-BLACK COTA” Practice Location

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