Healthcare Provider Details

I. General information

NPI: 1285985580
Provider Name (Legal Business Name): AJIBOLA ABODUNRIN OGUNDELE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 RICHMOND DR
MCKINNEY TX
75071-6059
US

IV. Provider business mailing address

801 RICHMOND DR
MCKINNEY TX
75071-6059
US

V. Phone/Fax

Practice location:
  • Phone: 972-839-3533
  • Fax: 214-338-2252
Mailing address:
  • Phone: 972-839-3533
  • Fax: 214-338-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number207818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: