Healthcare Provider Details

I. General information

NPI: 1154800167
Provider Name (Legal Business Name): KIMBERLY ANN PLATUPE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 HARMONY HLS
SPRING BRANCH TX
78070-2107
US

IV. Provider business mailing address

1100 STIRRUP DR
SPRING BRANCH TX
78070-6196
US

V. Phone/Fax

Practice location:
  • Phone: 830-438-1276
  • Fax:
Mailing address:
  • Phone: 520-444-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number213593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: