Provider Demographics
NPI:1205225786
Name:ESTRADA, VERONICA R (COTA)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:R
Last Name:ESTRADA
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 1:905 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SKIDMORE
Mailing Address - State:TX
Mailing Address - Zip Code:78389-3826
Mailing Address - Country:US
Mailing Address - Phone:361-813-3316
Mailing Address - Fax:
Practice Address - Street 1:905 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SKIDMORE
Practice Address - State:TX
Practice Address - Zip Code:78389-3826
Practice Address - Country:US
Practice Address - Phone:361-813-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209736224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant