Healthcare Provider Details

I. General information

NPI: 1396226403
Provider Name (Legal Business Name): GALA KAYE CZAJKOSKI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WEST HIGHTWAY 6
WACO TX
76712
US

IV. Provider business mailing address

300 WEST HIGHTWAY 6
WACO TX
76712
US

V. Phone/Fax

Practice location:
  • Phone: 254-761-8500
  • Fax: 847-441-0734
Mailing address:
  • Phone: 254-761-8500
  • Fax: 847-441-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number215032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: