Provider Demographics
NPI:1861162133
Name:OCHOA, MARK ANTHONY (COTA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:OCHOA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 CLABORNE ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4310
Mailing Address - Country:US
Mailing Address - Phone:956-878-3725
Mailing Address - Fax:
Practice Address - Street 1:2102 W TEEGE AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-4667
Practice Address - Country:US
Practice Address - Phone:956-412-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216587224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant