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General NPI Number Information
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NPI Number | 1497320873
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Entity Type | Individual
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Provider Name | MYCHAYLA TATYANA HARVEY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 8523 THACKERY ST
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City | DALLAS
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State | TX
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Zip | 75225-3903
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Country | US
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Telephone | 214-265-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 E TRINITY MILLS RD APT 1317
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City | CARROLLTON
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State | TX
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Zip | 75006-7824
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Country | US
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Telephone | 601-951-1792
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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 | 216548
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License Number State | TX
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