Healthcare Provider Details

I. General information

NPI: 1174005581
Provider Name (Legal Business Name): JOSIAS EUGENE COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSIAS EUGENE COTA

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 SAN LUCAS DR
CROWLEY TX
76036-4361
US

IV. Provider business mailing address

436 SAN LUCAS DR
CROWLEY TX
76036-4361
US

V. Phone/Fax

Practice location:
  • Phone: 321-806-5521
  • Fax:
Mailing address:
  • Phone: 321-806-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number213201
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: