Provider Demographics
NPI:1245773712
Name:MONYONCHO,, STEVE (COTA)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:MONYONCHO,
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3206
Mailing Address - Country:US
Mailing Address - Phone:972-288-7668
Mailing Address - Fax:
Practice Address - Street 1:825 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3206
Practice Address - Country:US
Practice Address - Phone:972-288-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213530224Z00000X
TX213540224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification