Provider Demographics
NPI:1457854879
Name:JARVIS, KATY JARVIS (COTA)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:JARVIS
Last Name:JARVIS
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 1:316 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6406
Mailing Address - Country:US
Mailing Address - Phone:254-709-7292
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON AVE STE 603
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1200
Practice Address - Country:US
Practice Address - Phone:254-296-9792
Practice Address - Fax:254-296-9086
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215054224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant