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General NPI Number Information
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NPI Number | 1740549732
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Entity Type | Individual
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Provider Name | TARA NICOLE MORRISON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 200 COUNTRY BROOK DR
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City | KELLER
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State | TX
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Zip | 76248-2125
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Country | US
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Telephone | 682-593-2742
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Fax |
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Provider Business Mailing Address
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Address Line | 5818 SANDSHELL CIR W APT 23103
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City | FORT WORTH
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State | TX
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Zip | 76137-7040
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Country | US
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Telephone | 575-607-5486
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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 | 213786
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License Number State | TX
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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 | OTA 13887
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License Number State | FL
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