Healthcare Provider Details

I. General information

NPI: 1073072856
Provider Name (Legal Business Name): KAMIE ZAVALA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAMIE ZAVALA COTA

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUESITO ST
CLINT TX
79836-5514
US

IV. Provider business mailing address

200 QUESITO ST
CLINT TX
79836-5514
US

V. Phone/Fax

Practice location:
  • Phone: 915-383-0526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number212100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: