Provider Demographics
NPI:1164904074
Name:AVERY, SONIA M (COTA)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:M
Last Name:AVERY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:M
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:4208 PARRY DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1477
Mailing Address - Country:US
Mailing Address - Phone:713-826-8137
Mailing Address - Fax:
Practice Address - Street 1:4208 PARRY DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1477
Practice Address - Country:US
Practice Address - Phone:713-826-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212060224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212060OtherTBOT