Provider Demographics
NPI:1174005581
Name:EUGENE, JOSIAS (COTA)
Entity Type:Individual
Prefix:
First Name:JOSIAS
Middle Name:
Last Name:EUGENE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:JOSIAS
Other - Middle Name:
Other - Last Name:EUGENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:436 SAN LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4361
Mailing Address - Country:US
Mailing Address - Phone:321-806-5521
Mailing Address - Fax:
Practice Address - Street 1:436 SAN LUCAS DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4361
Practice Address - Country:US
Practice Address - Phone:321-806-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213201225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
3218065521Other321806
TX$$$$$$$$$Medicaid