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General NPI Number Information
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NPI Number | 1043797145
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Entity Type | Individual
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Provider Name | BLAKE ABITUA COTA/L
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Gender | Male
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 2835 SHADOWBRIAR DR
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City | HOUSTON
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State | TX
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Zip | 77077-3267
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Country | US
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Telephone | 281-759-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 AUSTIN PKWY APT 1806
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City | SUGAR LAND
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State | TX
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Zip | 77479-1226
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Country | US
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Telephone | 713-303-6279
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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 | 215264
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License Number State | TX
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