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General NPI Number Information
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NPI Number | 1144704628
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Entity Type | Individual
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Provider Name | JESSICA DIAN THORNTON COTA
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Gender | Female
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 704 E DOBKINS ST
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City | DUBLIN
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State | TX
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Zip | 76446-2419
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Country | US
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Telephone | 254-216-1310
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 CR 616
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City | HAMILTON
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State | TX
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Zip | 76531
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Country | US
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Telephone | 254-216-1310
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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 | 214654
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License Number State | TX
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