Healthcare Provider Details

I. General information

NPI: 1154162550
Provider Name (Legal Business Name): ROBERT ERWIN COTA, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOBBY ERWIN

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 BURNET RD STE 204
AUSTIN TX
78728-6537
US

IV. Provider business mailing address

3311 CAVE DOME PATH
ROUND ROCK TX
78681-1093
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number217630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: