MEDICARE: MRS. MELISA NOEL HUMPHREY 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	214680	TX

General Provider Information

NPI Number	:	1013747153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISA NOEL HUMPHREY COTA

Provider Business Mailing Address
First Line	:	8515 BOULEVARD 26 APT 1905
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5655
Country	:	US
Telephone Number	:	972-955-1695
Fax Number	:

Provider Business Practice Location Address
First Line	:	8515 BOULEVARD 26 APT 1905
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5655
Country	:	US
Telephone Number	:	972-955-1695
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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