Provider Demographics
NPI:1255690012
Name:CONTRERAS, ELIA M (COTA)
Entity Type:Individual
Prefix:
First Name:ELIA
Middle Name:M
Last Name:CONTRERAS
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 1:619 E SAN JOSE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-1458
Mailing Address - Country:US
Mailing Address - Phone:956-774-5110
Mailing Address - Fax:956-722-3892
Practice Address - Street 1:619 E CALTON RD # 3
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3689
Practice Address - Country:US
Practice Address - Phone:956-722-3377
Practice Address - Fax:956-722-3892
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210187224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant