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General NPI Number Information
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NPI Number | 1649815333
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Entity Type | Individual
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Provider Name | JANEEN STUMPH COTA
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Gender | Female
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 207 S OLD BETSY RD
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City | KEENE
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State | TX
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Zip | 76059-2426
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Country | US
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Telephone | 817-645-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 10116 RAVENSWOOD RD
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City | GRANBURY
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State | TX
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Zip | 76049-4536
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Country | US
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Telephone | 817-240-3506
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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 | 214226
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License Number State | TX
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