Provider Demographics
NPI:1346573714
Name:DE LEON, MARIA LYDIA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LYDIA
Last Name:DE LEON
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 1:5850 FM 802
Mailing Address - Street 2:STE. F6
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78522
Mailing Address - Country:US
Mailing Address - Phone:956-554-0006
Mailing Address - Fax:
Practice Address - Street 1:4605 N JACKSON RD # RC
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6100
Practice Address - Country:US
Practice Address - Phone:956-631-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210026224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant