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NPI Code Detail

MEDICARE: MRS. KELLY DAWN GARCIA COTA

MEDICARE: MRS. KELLY DAWN GARCIA 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 Assistant216606TX

General Provider Information

NPI Number : 1164016333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY DAWN GARCIA COTA
Provider Business Mailing Address
First Line : 8023 PORTSMOUTH DR
Second Line :
City : SPRING BRANCH
State : TX
Zip : 78070-6436
Country : US
Telephone Number : 210-365-2786
Fax Number :
Provider Business Practice Location Address
First Line : 6870 HEUERMANN RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78256-9605
Country : US
Telephone Number : 210-592-4414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2021
Last Update Date : 02/26/2021

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