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General NPI Number Information
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NPI Number | 1720937600
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Entity Type | Individual
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Provider Name | BAILEY MAKENNA RASCO COTA
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Gender | Female
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Dates
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Enumeration Date | 01/24/2026
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 568 NW COUNTY ROAD 4040
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City | BLOOMING GROVE
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State | TX
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Zip | 76626-3026
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Country | US
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Telephone | 903-519-7471
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Fax |
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Provider Business Mailing Address
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Address Line | 568 NW COUNTY ROAD 4040
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City | BLOOMING GROVE
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State | TX
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Zip | 76626-3026
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Country | US
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Telephone | 903-519-7471
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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 | 219070
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License Number State | TX
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