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General NPI Number Information
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NPI Number | 1720244544
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Entity Type | Individual
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Provider Name | EL TEGRA COWART LPTA/COTA
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Gender | Male
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1648 EAGLES LANDING BLVD APT 116
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City | TALLAHASSEE
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State | FL
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Zip | 32308-1561
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Country | US
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Telephone | 706-825-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 1648 EAGLES LANDING BLVD APT 116
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City | TALLAHASSEE
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State | FL
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Zip | 32308-1561
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Country | US
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Telephone | 706-825-6904
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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 | OTA10679
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA000825
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2509
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA21259
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA002206
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License Number State | GA
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