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General NPI Number Information
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NPI Number | 1437453289
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Entity Type | Individual
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Provider Name | DEDREA DIANN HIGGINBOTHAM COTA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 901 SEVEN OAKS RD
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City | BONHAM
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State | TX
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Zip | 75418-3237
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Country | US
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Telephone | 903-583-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 208 KEY RD
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City | SHERMAN
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State | TX
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Zip | 75090-7545
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Country | US
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Telephone | 903-436-0464
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Fax | 903-891-0558
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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 | 208626
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License Number State | TX
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