Provider Demographics
NPI:1144619883
Name:HIAR, CRETTA (COTA, LVN)
Entity Type:Individual
Prefix:
First Name:CRETTA
Middle Name:
Last Name:HIAR
Suffix:
Gender:F
Credentials:COTA, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 COUNTY ROAD 638
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-5141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:493 COUNTY ROAD 638
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-5141
Practice Address - Country:US
Practice Address - Phone:713-503-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194058164X00000X
TX211002224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No164X00000XNursing Service ProvidersLicensed Vocational Nurse