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General NPI Number Information
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NPI Number | 1760654644
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Entity Type | Individual
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Provider Name | CAROL LYLE WILSON COTA
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Gender | Female
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 5101 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4801
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Country | US
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Telephone | 210-616-0100
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Fax | 210-592-5491
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Provider Business Mailing Address
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Address Line | 13603 LYTLE LN
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City | HELOTES
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State | TX
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Zip | 78023-2978
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Country | US
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Telephone | 210-695-1446
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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 | 209034
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License Number State | TX
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