Healthcare Provider Details

I. General information

NPI: 1013187509
Provider Name (Legal Business Name): KIMBERLY FAGAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E JACKSON ST
HARLINGEN TX
78550-6846
US

IV. Provider business mailing address

2518 JEFF ST
HARLINGEN TX
78550-3313
US

V. Phone/Fax

Practice location:
  • Phone: 956-425-3338
  • Fax:
Mailing address:
  • Phone: 210-393-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209760
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: