Provider Demographics
NPI:1760866933
Name:REESE, LASHANDA (COTA)
Entity Type:Individual
Prefix:
First Name:LASHANDA
Middle Name:
Last Name:REESE
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 1:6003 OLD BULLARD RD APT 196
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4248
Mailing Address - Country:US
Mailing Address - Phone:318-267-4580
Mailing Address - Fax:
Practice Address - Street 1:810 S PORTER AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2300
Practice Address - Country:US
Practice Address - Phone:903-593-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212063224Z00000X
LAOTA.200224224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant