Provider Demographics
NPI:1730700790
Name:TAPIA, JEANETTE MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:TAPIA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:MARIE
Other - Last Name:TAPIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:5000 BRAGG AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3406
Mailing Address - Country:US
Mailing Address - Phone:915-887-9966
Mailing Address - Fax:
Practice Address - Street 1:5000 BRAGG AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-3406
Practice Address - Country:US
Practice Address - Phone:915-887-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216004224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant