Provider Demographics
NPI:1881711091
Name:CROCKETT, LARRY GENE (COTA)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GENE
Last Name:CROCKETT
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2345 FM 1750
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-5509
Mailing Address - Country:US
Mailing Address - Phone:235-437-1184
Mailing Address - Fax:325-437-3314
Practice Address - Street 1:2617 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5109
Practice Address - Country:US
Practice Address - Phone:325-437-1184
Practice Address - Fax:325-437-3314
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202625224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant