Healthcare Provider Details

I. General information

NPI: 1679387682
Provider Name (Legal Business Name): MAKAYLA LYNN IORDACHE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR STE 200
SPRING TX
77379-4895
US

IV. Provider business mailing address

16835 DEER CREEK DR STE 200
SPRING TX
77379-4895
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax:
Mailing address:
  • Phone: 281-379-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number218648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: