Healthcare Provider Details

I. General information

NPI: 1427586999
Provider Name (Legal Business Name): ELIZABETH MARIE KOTARA H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34910 INTERSTATE 10 W STE 403
BOERNE TX
78006-9268
US

IV. Provider business mailing address

103 RIVER OAKS RD
COMFORT TX
78013-2711
US

V. Phone/Fax

Practice location:
  • Phone: 830-331-8511
  • Fax:
Mailing address:
  • Phone: 830-370-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: