Provider Demographics
NPI:1083280283
Name:DEMOLAY, MONICA SOUN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:SOUN
Last Name:DEMOLAY
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 1:2000 HOMEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5637
Mailing Address - Country:US
Mailing Address - Phone:702-427-5883
Mailing Address - Fax:
Practice Address - Street 1:2500 BARTON SKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4601
Practice Address - Country:US
Practice Address - Phone:866-607-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216747224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant