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General NPI Number Information
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NPI Number | 1134683659
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Entity Type | Individual
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Provider Name | JESSICA JAIMES COTA
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Gender | Female
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 201 CROSBY ST
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City | MANSFIELD
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State | LA
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Zip | 71052-2613
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Country | US
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Telephone | 318-872-2836
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Fax |
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Provider Business Mailing Address
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Address Line | 4495 SMYRNA RD
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City | GRAND CANE
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State | LA
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Zip | 71032-5750
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Country | US
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Telephone | 318-286-6662
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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 | OTA.200181
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License Number State | LA
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