MEDICARE: SHELLY STEWARD COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	210971	TX

General Provider Information

NPI Number	:	1013372150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY STEWARD COTA

Provider Business Mailing Address
First Line	:	4920 MAGNOLIA COVE DR
Second Line	:	3108
City	:	KINGWOOD
State	:	TX
Zip	:	77345-2247
Country	:	US
Telephone Number	:	281-851-5881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 RIVERWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1939
Country	:	US
Telephone Number	:	713-965-9998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/16/2015

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Directions to “ SHELLY STEWARD COTA” Practice Location

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