Provider Demographics
NPI:1861731028
Name:ROWAN, CELESTE POTTER (COTA)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:POTTER
Last Name:ROWAN
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 1:139 SPARKS COLONY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-7326
Mailing Address - Country:US
Mailing Address - Phone:361-463-9234
Mailing Address - Fax:
Practice Address - Street 1:114 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3101
Practice Address - Country:US
Practice Address - Phone:361-576-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208799224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant