Provider Demographics
NPI:1033696950
Name:ORTIZ, BIANCA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 NE I AVENUE
Mailing Address - Street 2:PO BOX 4472
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838
Mailing Address - Country:US
Mailing Address - Phone:915-667-6014
Mailing Address - Fax:
Practice Address - Street 1:1514 N ZARAGOZA RD STE B4
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-8041
Practice Address - Country:US
Practice Address - Phone:915-257-5782
Practice Address - Fax:915-257-4027
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215288224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant