Healthcare Provider Details

I. General information

NPI: 1184336737
Provider Name (Legal Business Name): KRISTYNA EMILY MOSES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTYNA EMILY SHAFFER

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 LAKE WOODLANDS DR # F
THE WOODLANDS TX
77382-2566
US

IV. Provider business mailing address

8122 LEGACY CREEK DR
TOMBALL TX
77375-1199
US

V. Phone/Fax

Practice location:
  • Phone: 281-364-1122
  • Fax:
Mailing address:
  • Phone: 713-870-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number217213
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: