Healthcare Provider Details

I. General information

NPI: 1548742018
Provider Name (Legal Business Name): ANN MARIE HEUERTZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 SUMMER CREST DR
SAN ANGELO TX
76901-9782
US

IV. Provider business mailing address

2714 RED BLUFF RAMP RD
SAN ANGELO TX
76904-7844
US

V. Phone/Fax

Practice location:
  • Phone: 325-942-7700
  • Fax:
Mailing address:
  • Phone: 325-212-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number207165
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: