MEDICARE: VICKI LUONG 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	218283	TX

General Provider Information

NPI Number	:	1134971070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LUONG COTA

Provider Business Mailing Address
First Line	:	16311 S TEMPLE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5919
Country	:	US
Telephone Number	:	832-640-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	18502 GREEN LAND WAY STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7967
Country	:	US
Telephone Number	:	281-717-4308
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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