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General NPI Number Information
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NPI Number | 1164900999
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Entity Type | Individual
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Provider Name | BIANCA CRYSTAL RETANA COTA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 1411 DENVER AVE
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City | DALHART
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State | TX
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Zip | 79022-4809
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Country | US
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Telephone | 806-244-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 BOB WHITE AVE
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City | DUMAS
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State | TX
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Zip | 79029-5382
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Country | US
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Telephone | 806-930-8154
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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 | 215324
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License Number State | TX
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