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General NPI Number Information
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NPI Number | 1235604794
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Entity Type | Individual
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Provider Name | LINDSEY PENNER COTA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 1154 E HAWKINS PKWY
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City | LONGVIEW
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State | TX
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Zip | 75605-7975
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Country | US
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Telephone | 903-663-2750
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 N MAIN ST
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City | GLADEWATER
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State | TX
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Zip | 75647-5373
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Country | US
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Telephone | 512-584-1417
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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 | 211351
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License Number State | TX
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