Healthcare Provider Details

I. General information

NPI: 1699401646
Provider Name (Legal Business Name): MIARA L ANTHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIARA CARR COTA

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 GREENE ST
WEBSTER TX
77598-6701
US

IV. Provider business mailing address

2410 POPLAR COPSE CT
SPRING TX
77373-2077
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-4738
  • Fax:
Mailing address:
  • Phone: 440-983-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number216811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: