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General NPI Number Information
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NPI Number | 1659570273
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Entity Type | Individual
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Provider Name | GLENN F. MOBLEY SR. COTA
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2950 1/2 LAKEVIEW RD
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City | SHREVEPORT
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State | LA
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Zip | 71107
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Country | US
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Telephone | 318-459-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 2482 ARMFIELD RD
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City | OAK GROVE
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State | LA
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Zip | 71263-6819
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Country | US
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Telephone | 318-230-6127
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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 | 3561
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License Number State | AZ
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