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NPI Code Detail

MEDICARE: SHANNON ATTEBERY COTA

MEDICARE:   SHANNON  ATTEBERY  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 Assistant214844TX

General Provider Information

NPI Number : 1487166377
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ATTEBERY COTA
Provider Business Mailing Address
First Line : 196 COUNTY ROAD 4859
Second Line :
City : NEWARK
State : TX
Zip : 76071-3422
Country : US
Telephone Number : 845-625-3803
Fax Number :
Provider Business Practice Location Address
First Line : 14651 DALLAS PKWY STE 200
Second Line :
City : DALLAS
State : TX
Zip : 75254-8856
Country : US
Telephone Number : 866-919-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2017
Last Update Date : 09/17/2021

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Directions to “ SHANNON ATTEBERY COTA” Practice Location

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