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General NPI Number Information
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NPI Number | 1053894725
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Entity Type | Individual
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Provider Name | CHAD DEVOSE COTA
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Gender | Male
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 9300LAKEVIEW PARKWAY
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City | ROWLETT
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State | TX
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Zip | 75088
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Country | US
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Telephone | 469-734-6225
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Fax |
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Provider Business Mailing Address
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Address Line | 575 NE LOOP 820 APT 1018
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City | HURST
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State | TX
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Zip | 76053-6180
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Country | US
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Telephone | 817-846-5285
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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 | 215144
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License Number State | TX
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