Provider Demographics
NPI:1164016333
Name:GARCIA, KELLY DAWN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DAWN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:DAWN
Other - Last Name:ESQUIVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8023 PORTSMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6436
Mailing Address - Country:US
Mailing Address - Phone:210-365-2786
Mailing Address - Fax:
Practice Address - Street 1:6870 HEUERMANN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9605
Practice Address - Country:US
Practice Address - Phone:210-592-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216606224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant