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General NPI Number Information
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NPI Number | 1942750997
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Entity Type | Individual
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Provider Name | MARISSA PERRY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 680 EXECUTIVE DR APT 5311
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City | PLANO
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State | TX
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Zip | 75074-0263
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Country | US
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Telephone | 972-977-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 74 3RD ST
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City | CLEVELAND
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State | MS
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Zip | 38732-9745
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Country | US
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Telephone | 662-721-0272
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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 | TA3155
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License Number State | MS
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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 | 215593
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License Number State | TX
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