Healthcare Provider Details

I. General information

NPI: 1023584844
Provider Name (Legal Business Name): KELSEY E GARRETT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MANOR DR
BRYAN TX
77802-1907
US

IV. Provider business mailing address

747 3RD ST
SOMERVILLE TX
77879-4519
US

V. Phone/Fax

Practice location:
  • Phone: 979-821-7300
  • Fax:
Mailing address:
  • Phone: 575-791-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number215347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: