Provider Demographics
NPI:1548743933
Name:MILAM, SYLVIA VILLARREAL (COTA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:VILLARREAL
Last Name:MILAM
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 1:2222 GLEN IVY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3005
Mailing Address - Country:US
Mailing Address - Phone:210-550-9636
Mailing Address - Fax:
Practice Address - Street 1:8800 FOURWINDS DR
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1918
Practice Address - Country:US
Practice Address - Phone:210-637-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205770224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant