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NPI Code Detail

MEDICARE: DORENNA WALZ COTA

MEDICARE: DORENNA WALZ 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 Assistant209507TX

General Provider Information

NPI Number : 1376008326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORENNA WALZ COTA
Provider Business Mailing Address
First Line : 7620 HIDDEN HOLLOW DR
Second Line :
City : WACO
State : TX
Zip : 76712-3870
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 763 MARLANDWOOD RD
Second Line :
City : TEMPLE
State : TX
Zip : 76502-3573
Country : US
Telephone Number : 254-771-5950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2019
Last Update Date : 02/04/2019

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Directions to “ DORENNA WALZ COTA” Practice Location

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