Provider Demographics
NPI:1962983296
Name:SCOTT, JALECIA UNIQUE (COTA)
Entity type:Individual
Prefix:
First Name:JALECIA
Middle Name:UNIQUE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 N SAM HOUSTON PKWY W STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1466
Mailing Address - Country:US
Mailing Address - Phone:832-968-7155
Mailing Address - Fax:713-383-9795
Practice Address - Street 1:4100 N SAM HOUSTON PKWY W STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-1466
Practice Address - Country:US
Practice Address - Phone:832-968-7155
Practice Address - Fax:713-383-9795
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215268224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant