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General NPI Number Information
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NPI Number | 1245036912
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Entity Type | Individual
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Provider Name | JESSICA D GOLIAS COTA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 966 N GARDEN RIDGE BLVD
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City | LEWISVILLE
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State | TX
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Zip | 75077-2827
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Country | US
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Telephone | 972-420-6605
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Fax |
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Provider Business Mailing Address
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Address Line | 3608 COOPER BR W
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City | DENTON
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State | TX
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Zip | 76209-7918
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Country | US
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Telephone | 940-391-8092
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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 | 217758
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License Number State | TX
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