Healthcare Provider Details

I. General information

NPI: 1558538322
Provider Name (Legal Business Name): CYNTHIA LOUISE ALLRED COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 INTERNATIONAL PKWY STE 2051
HEATHROW FL
32746-5352
US

IV. Provider business mailing address

12699 MAXWELL ST
WILLIS TX
77378-2785
US

V. Phone/Fax

Practice location:
  • Phone: 800-798-6035
  • Fax: 888-798-6035
Mailing address:
  • Phone: 936-228-0408
  • Fax: 936-228-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: