Provider Demographics
NPI:1457831380
Name:NOLAN, CYNTHIA LAVERN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LAVERN
Last Name:NOLAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:19221 I-45 S. SUITE 120
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385
Mailing Address - Country:US
Mailing Address - Phone:936-585-5019
Mailing Address - Fax:
Practice Address - Street 1:19221 I-45 S. SUITE 120
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:936-585-5019
Practice Address - Fax:936-585-4416
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214290224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant