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General NPI Number Information
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NPI Number | 1134601701
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Entity Type | Individual
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Provider Name | MARTHA JANE MANN COTA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 1720 N LOGAN ST
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City | TEXAS CITY
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State | TX
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Zip | 77590-4931
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Country | US
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Telephone | 361-571-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 LOUISIANA AVE APT 8103
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City | LEAGUE CITY
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State | TX
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Zip | 77573-5963
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Country | US
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Telephone | 361-571-1223
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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 | 200981
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License Number State | TX
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