Provider Demographics
NPI:1225645609
Name:AVILA, MARIBEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:AVILA
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 1:10073 MANITOBA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4134
Mailing Address - Country:US
Mailing Address - Phone:915-781-3724
Mailing Address - Fax:
Practice Address - Street 1:10073 MANITOBA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4134
Practice Address - Country:US
Practice Address - Phone:915-781-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216417224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant