Provider Demographics
NPI:1548078173
Name:RHODES, JASON QUINTON (COTA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:QUINTON
Last Name:RHODES
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 S OLD BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75833-1917
Mailing Address - Country:US
Mailing Address - Phone:903-602-2025
Mailing Address - Fax:
Practice Address - Street 1:1600 JOSEPH DR STE 2000
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1502
Practice Address - Country:US
Practice Address - Phone:979-213-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216452224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant