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General NPI Number Information
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NPI Number | 1972084143
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Entity Type | Individual
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Provider Name | KAYLA MARIE STANLEY COTA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 1104 S WILLIAM ST
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City | ATLANTA
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State | TX
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Zip | 75551-3246
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Country | US
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Telephone | 870-949-5334
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Fax |
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Provider Business Mailing Address
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Address Line | 14333 TEXAS HIGHWAY 8
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City | DOUGLASSVILLE
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State | TX
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Zip | 75560-4606
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Country | US
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Telephone | 903-799-0883
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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 | 213054
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License Number State | TX
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