Healthcare Provider Details

I. General information

NPI: 1811664477
Provider Name (Legal Business Name): HALEY ELISABETH ARNETTE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

6114 GINITA LN
AUSTIN TX
78739-1640
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4711
  • Fax:
Mailing address:
  • Phone: 512-705-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number457058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: