Provider Demographics
NPI:1477949733
Name:DE ANDA, MIGUEL ANDRES (COTA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANDRES
Last Name:DE ANDA
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 1:1600 WICKERSHAM LANE
Mailing Address - Street 2:APT. 1046
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741
Mailing Address - Country:US
Mailing Address - Phone:956-639-8734
Mailing Address - Fax:
Practice Address - Street 1:1600 WICKERSHAM LANE
Practice Address - Street 2:APT. 1046
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:956-639-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant