Provider Demographics
NPI:1427586999
Name:KOTARA, ELIZABETH MARIE (HIS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:KOTARA
Suffix:
Gender:
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-2711
Mailing Address - Country:US
Mailing Address - Phone:830-370-2583
Mailing Address - Fax:
Practice Address - Street 1:34910 INTERSTATE 10 W STE 403
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9268
Practice Address - Country:US
Practice Address - Phone:830-331-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80500237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist