Healthcare Provider Details

I. General information

NPI: 1144898248
Provider Name (Legal Business Name): AMY BETH ESCAMILLA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY BETH FUNKHOUSER COTA

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 IOLA AVE
LUBBOCK TX
79424-7845
US

IV. Provider business mailing address

6720 28TH ST APT 508
LUBBOCK TX
79407-2869
US

V. Phone/Fax

Practice location:
  • Phone: 806-687-6640
  • Fax:
Mailing address:
  • Phone: 806-777-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: