Provider Demographics
NPI:1144728668
Name:MOLLEDA GREENE, MICHELE ANN (COTA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:MOLLEDA GREENE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:MOLLEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1211 ARCADIA PATH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245
Mailing Address - Country:US
Mailing Address - Phone:210-448-9111
Mailing Address - Fax:
Practice Address - Street 1:1211 ARCADIA PATH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245
Practice Address - Country:US
Practice Address - Phone:210-448-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210254224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant