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General NPI Number Information
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NPI Number | 1417181215
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Entity Type | Individual
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Provider Name | SHIRLEY ANN MADARY COTA
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Gender | Female
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 917 BEVILLE RD STE G
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119
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Country | US
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Telephone | 800-330-7711
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Fax | 866-426-2811
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Provider Business Mailing Address
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Address Line | 333 WATER ST APT D4
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City | KERRVILLE
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State | TX
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Zip | 78028-5232
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Country | US
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Telephone | 830-459-7376
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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 | 205951
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License Number State | TX
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