Provider Demographics
NPI:1609017169
Name:COYLE, MARY T (COTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:COYLE
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0607
Mailing Address - Country:US
Mailing Address - Phone:256-591-0135
Mailing Address - Fax:
Practice Address - Street 1:325 N SAINT PAUL ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3801
Practice Address - Country:US
Practice Address - Phone:866-953-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210279224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant