Healthcare Provider Details

I. General information

NPI: 1770256455
Provider Name (Legal Business Name): TIFFANY OKONKWO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12777 BEECHNUT ST
HOUSTON TX
77072-3820
US

IV. Provider business mailing address

5755 ALMEDA RD UNIT 311
HOUSTON TX
77004-8110
US

V. Phone/Fax

Practice location:
  • Phone: 281-879-8040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number215205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: