Provider Demographics
NPI:1467099572
Name:ARELLANO, GLORIA LIZETH (COTA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:LIZETH
Last Name:ARELLANO
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 1:120 COUNTY ROAD 1041
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-5576
Mailing Address - Country:US
Mailing Address - Phone:903-238-1703
Mailing Address - Fax:
Practice Address - Street 1:158 COUNTY ROAD 1212
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:TX
Practice Address - Zip Code:75643-4357
Practice Address - Country:US
Practice Address - Phone:903-754-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216011224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant