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General NPI Number Information
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NPI Number | 1659157907
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Entity Type | Individual
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Provider Name | SHAUNA RACHEL COOPER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 706 RED COAT DR
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City | TEMPLE
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State | TX
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Zip | 76504-2200
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Country | US
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Telephone | 254-742-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 EATON DR
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City | TEMPLE
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State | TX
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Zip | 76504-8683
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Country | US
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Telephone | 214-931-4119
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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 | 210870
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License Number State | TX
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