Provider Demographics
NPI:1093094500
Name:WELLS, SHEENA NICOLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:NICOLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:SHEENA
Other - Middle Name:NICOLE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:1140 HOBO LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-4869
Mailing Address - Country:US
Mailing Address - Phone:832-671-9955
Mailing Address - Fax:
Practice Address - Street 1:1318 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5215
Practice Address - Country:US
Practice Address - Phone:979-776-2872
Practice Address - Fax:979-776-1456
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210697224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant