Healthcare Provider Details

I. General information

NPI: 1770366221
Provider Name (Legal Business Name): SUGAR RAYE REED COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18311 CAMPBELLFORD DR
TOMBALL TX
77377-7988
US

IV. Provider business mailing address

18311 CAMPBELLFORD DR
TOMBALL TX
77377-7988
US

V. Phone/Fax

Practice location:
  • Phone: 713-594-1644
  • Fax:
Mailing address:
  • Phone: 713-594-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number217103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: