Healthcare Provider Details

I. General information

NPI: 1619445095
Provider Name (Legal Business Name): JODY VERCHER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY SMITH COTA

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 CONTRAIL DR
KEARNEYSVILLE WV
25430-2899
US

IV. Provider business mailing address

149 CONTRAIL DR
KEARNEYSVILLE WV
25430-2899
US

V. Phone/Fax

Practice location:
  • Phone: 713-305-3453
  • Fax:
Mailing address:
  • Phone: 713-305-3453
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number213286
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2165
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: