Healthcare Provider Details

I. General information

NPI: 1407335037
Provider Name (Legal Business Name): SHAWNA MICHELLE BLAIR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1814 ATRIUM PLACE DR
HARLINGEN TX
78550-2583
US

IV. Provider business mailing address

20490 FM 1018
LYFORD TX
78569-2229
US

V. Phone/Fax

Practice location:
  • Phone: 956-230-2300
  • Fax:
Mailing address:
  • Phone: 956-535-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number208971
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: