Healthcare Provider Details

I. General information

NPI: 1912489386
Provider Name (Legal Business Name): STEPHANIE MARIE HELLMAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 09/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 SHERMAN DRIVE
WHITESBORO TX
76273
US

IV. Provider business mailing address

1512 TIMBER CREEK DRIVE
HOWE TX
75459
US

V. Phone/Fax

Practice location:
  • Phone: 903-564-7900
  • Fax:
Mailing address:
  • Phone: 903-209-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: