Provider Demographics
NPI:1033775341
Name:VENCES, MICHELLE GARCIA (COTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GARCIA
Last Name:VENCES
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 BETELGEUSE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4855
Mailing Address - Country:US
Mailing Address - Phone:210-889-5799
Mailing Address - Fax:
Practice Address - Street 1:119 SW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2101
Practice Address - Country:US
Practice Address - Phone:210-745-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
215273224Z00000X
TX8132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant