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General NPI Number Information
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NPI Number | 1215354915
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Entity Type | Individual
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Provider Name | KRISTY SHARP COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 1315 WALNUT ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4446
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Country | US
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Telephone | 903-794-2705
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Fax | 903-793-1203
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Provider Business Mailing Address
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Address Line | 776 HIGHWAY 317
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City | LOCKESBURG
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State | AR
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Zip | 71846-9480
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Country | US
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Telephone | 870-784-1892
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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 | 212563
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License Number State | TX
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