MEDICARE: GINA IKOGOR-ISIKALU 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	215275	TX

General Provider Information

NPI Number	:	1427531003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA IKOGOR-ISIKALU COTA

Provider Business Mailing Address
First Line	:	5507 CASA CALVET DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-1636
Country	:	US
Telephone Number	:	832-260-6689
Fax Number	:

Provider Business Practice Location Address
First Line	:	5507 CASA CALVET DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-1636
Country	:	US
Telephone Number	:	832-260-6689
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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