Provider Demographics
NPI:1518366251
Name:FELTON, CYNTHIA L (COTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:FELTON
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 1:1724 MARTIN DR APT 6205
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6291
Mailing Address - Country:US
Mailing Address - Phone:570-772-1556
Mailing Address - Fax:
Practice Address - Street 1:1724 MARTIN DR APT 6205
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6291
Practice Address - Country:US
Practice Address - Phone:157-077-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007842224Z00000X
TX212669224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant