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General NPI Number Information
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NPI Number | 1912528498
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Entity Type | Individual
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Provider Name | BROOKE NICOLE MCDANIEL COTA
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Gender | Female
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 3414 GOLDEN RD
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City | TYLER
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State | TX
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Zip | 75701-8336
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Country | US
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Telephone | 903-939-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 227 WILLOWBROOK LN
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City | WHITEHOUSE
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State | TX
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Zip | 75791-3499
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Country | US
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Telephone | 903-720-0615
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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 | 215001
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License Number State | TX
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