Provider Demographics
NPI:1174416291
Name:CANO, BETHANY ALYSSA (COTA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ALYSSA
Last Name:CANO
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 1:2518 CABEZA DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2174
Mailing Address - Country:US
Mailing Address - Phone:832-235-7357
Mailing Address - Fax:
Practice Address - Street 1:2907 BROADWAY BEND DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2236
Practice Address - Country:US
Practice Address - Phone:346-626-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218759224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty