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General NPI Number Information
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NPI Number | 1679396774
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Entity Type | Individual
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Provider Name | JAYSEN J MUNIZ SANCHEZ COTA/L
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Gender | Male
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 9059 GARDENER LOOP RD
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City | JOINT BASE LEWIS-MCCHORD
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State | WA
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Zip | 98433
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Country | US
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Telephone | 787-560-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 BARNES CT SW APT 407
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City | TUMWATER
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State | WA
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Zip | 98512-1460
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Country | US
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Telephone | 787-560-2937
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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 | 218449
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License Number State | TX
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