Provider Demographics
NPI:1073014221
Name:FLORES, ELENA (COTA)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:OLVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4362 US HIGHWAY 259 N
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7674
Mailing Address - Country:US
Mailing Address - Phone:903-212-7716
Mailing Address - Fax:
Practice Address - Street 1:4362 US HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7674
Practice Address - Country:US
Practice Address - Phone:903-212-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214361224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant