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General NPI Number Information
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NPI Number | 1194437327
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Entity Type | Individual
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Provider Name | BRANDICE MARIE MORENO COTA
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 855 E BASSE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1890
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Country | US
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Telephone | 210-930-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 2742 CINNAMON TEAL
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-1256
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Country | US
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Telephone | 210-857-9133
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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 | 210517
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License Number State | TX
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