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NPI Code Detail

MEDICARE: PAULA JAN PETERS COTA

MEDICARE: PAULA JAN PETERS 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
1224Z00000XOccupational Therapy Assistant212455TX

General Provider Information

NPI Number : 1154803658
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA JAN PETERS COTA
Provider Business Mailing Address
First Line : 526 TRAILBLAZER RD
Second Line :
City : FORNEY
State : TX
Zip : 75126-4732
Country : US
Telephone Number : 214-284-3071
Fax Number :
Provider Business Practice Location Address
First Line : 505 W CENTERVILLE RD
Second Line :
City : GARLAND
State : TX
Zip : 75041-5445
Country : US
Telephone Number : 972-840-0970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2018
Last Update Date : 08/30/2018

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