Provider Demographics
NPI:1871922104
Name:AGOLD, TERRI (COTA)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:
Last Name:AGOLD
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 1:8424 WILLOW LOCH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7497
Mailing Address - Country:US
Mailing Address - Phone:281-507-3263
Mailing Address - Fax:
Practice Address - Street 1:9505 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3799
Practice Address - Country:US
Practice Address - Phone:281-430-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209313224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant