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General NPI Number Information
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NPI Number | 1477949253
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Entity Type | Individual
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Provider Name | CONSTANCE SUE GRANT I COTA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 7501 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79124-2150
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Country | US
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Telephone | 806-467-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 4714 S AUSTIN ST
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City | AMARILLO
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State | TX
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Zip | 79110-2405
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Country | US
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Telephone | 806-570-0529
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Fax | 806-367-7907
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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 | 207514
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | 207514
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License Number State | TX
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