Provider Demographics
NPI:1124398318
Name:JORDAN, OQUISHA LASHAY (COTA)
Entity Type:Individual
Prefix:MS
First Name:OQUISHA
Middle Name:LASHAY
Last Name:JORDAN
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 1:900 W FORDALL ST APT 19
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-6417
Mailing Address - Country:US
Mailing Address - Phone:903-445-1654
Mailing Address - Fax:
Practice Address - Street 1:900 W FORDALL ST APT 19
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6417
Practice Address - Country:US
Practice Address - Phone:903-445-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211088224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant