Provider Demographics
NPI:1972083970
Name:WRIGHT, FAITH NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:NICOLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:NICOLE
Other - Last Name:MUSCARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1700 MARLANDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2842
Mailing Address - Country:US
Mailing Address - Phone:254-743-6200
Mailing Address - Fax:
Practice Address - Street 1:1700 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2842
Practice Address - Country:US
Practice Address - Phone:254-743-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213978224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant