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General NPI Number Information
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NPI Number | 1013484732
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Entity Type | Individual
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Provider Name | MORGAN NICOLE PEDEN JUDICE COTA
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Gender | Female
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 604 FM 1293 RD
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City | KOUNTZE
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State | TX
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Zip | 77625-7804
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Country | US
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Telephone | 409-658-0961
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Fax |
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Provider Business Mailing Address
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Address Line | 1390 KALAS CIR
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City | LUMBERTON
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State | TX
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Zip | 77657-1172
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Country | US
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Telephone | 409-658-0961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 214851
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License Number State |
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