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NPI Code Detail

MEDICARE: MR. BREANNE LANDIVAR COTA

MEDICARE: MR. BREANNE LANDIVAR 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 Assistant209729TX

General Provider Information

NPI Number : 1528250644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BREANNE LANDIVAR COTA
Provider Business Mailing Address
First Line : 130 SPENCER LN
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78201-2109
Country : US
Telephone Number : 210-444-9186
Fax Number :
Provider Business Practice Location Address
First Line : 130 SPENCER LN
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78201-2109
Country : US
Telephone Number : 210-444-9186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2007
Last Update Date : 08/13/2007

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Directions to “ MR. BREANNE LANDIVAR COTA” Practice Location

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