Healthcare Provider Details

I. General information

NPI: 1063246494
Provider Name (Legal Business Name): JENNIFER NORTON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 LITTLE DRAW LN
LEANDER TX
78641-5213
US

IV. Provider business mailing address

1112 E COPELAND RD STE 300
ARLINGTON TX
76011-4910
US

V. Phone/Fax

Practice location:
  • Phone: 352-552-5203
  • Fax:
Mailing address:
  • Phone: 817-505-2575
  • Fax: 833-214-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number217806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: