Healthcare Provider Details

I. General information

NPI: 1033699699
Provider Name (Legal Business Name): KIMBERLY ALVARADO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W MAIN ST
EDNA TX
77957
US

IV. Provider business mailing address

902 COLLEGE ST
EL CAMPO TX
77437-2805
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-7614
  • Fax:
Mailing address:
  • Phone: 979-332-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number207965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: