Provider Demographics
NPI:1124539754
Name:SOTO, REAGAN A (COTA)
Entity Type:Individual
Prefix:MS
First Name:REAGAN
Middle Name:A
Last Name:SOTO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:ALEXANDRA
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6502 SLIDE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1118 S BEVERLY DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5525
Practice Address - Country:US
Practice Address - Phone:806-282-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214763224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant