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General NPI Number Information
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NPI Number | 1912487885
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Entity Type | Individual
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Provider Name | COTY SHUPTRINE COTA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 3737 N GARLAND AVE
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City | GARLAND
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State | TX
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Zip | 75040-8502
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Country | US
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Telephone | 972-495-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 TRANQUILITY LN APT 3206
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City | ROWLETT
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State | TX
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Zip | 75089-0141
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Country | US
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Telephone |
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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 | 213966
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License Number State | TX
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