Provider Demographics
NPI:1083194286
Name:SOTO, KAYDENE M (COTA)
Entity Type:Individual
Prefix:
First Name:KAYDENE
Middle Name:M
Last Name:SOTO
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 1:2700 TRIMMIER RD APT 8106
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6046
Mailing Address - Country:US
Mailing Address - Phone:832-484-3756
Mailing Address - Fax:
Practice Address - Street 1:2700 TRIMMIER RD APT 8106
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6046
Practice Address - Country:US
Practice Address - Phone:832-722-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212014224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant