Provider Demographics
NPI:1083737597
Name:VASQUEZ, LUDIM ETHEL (COTA)
Entity Type:Individual
Prefix:
First Name:LUDIM
Middle Name:ETHEL
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 BRUSHMEADE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8821
Mailing Address - Country:US
Mailing Address - Phone:281-342-6809
Mailing Address - Fax:
Practice Address - Street 1:2110 BRUSHMEADE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8821
Practice Address - Country:US
Practice Address - Phone:281-342-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208220224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant