Healthcare Provider Details

I. General information

NPI: 1417181215
Provider Name (Legal Business Name): SHIRLEY ANN MADARY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 BEVILLE RD STE G
SOUTH DAYTONA FL
32119
US

IV. Provider business mailing address

333 WATER ST APT D4
KERRVILLE TX
78028-5232
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax: 866-426-2811
Mailing address:
  • Phone: 830-459-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number205951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: