Provider Demographics
NPI:1558826099
Name:LYLES, SANDRA CECILIA (COTA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CECILIA
Last Name:LYLES
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 1:9036 MOUNT SHASTA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1550
Mailing Address - Country:US
Mailing Address - Phone:915-276-6155
Mailing Address - Fax:
Practice Address - Street 1:9036 MOUNT SHASTA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1550
Practice Address - Country:US
Practice Address - Phone:915-276-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214989224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant