=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558538322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA LOUISE ALLRED COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 06/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1485 INTERNATIONAL PKWY STE 2051
-----------------------------------------------------
City | HEATHROW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-5352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-798-6035
-----------------------------------------------------
Fax | 888-798-6035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12699 MAXWELL ST
-----------------------------------------------------
City | WILLIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77378-2785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-228-0408
-----------------------------------------------------
Fax | 936-228-0408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 209291
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------